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Director's Report to the National Advisory Council on Drug Abuse - September, 2006

Research Findings - Epidemiology and Etiology Research

Individual Differences in Childhood Neurobehavior Disinhibition Predict Decision to Desist Substance Use during Adolescence and Substance Use Disorder in Young Adulthood

Genetic, physiological and psychological investigations have demonstrated that deficient inhibitory regulation amplifies the risk for substance use disorder (SUD). This study extends this line of research by determining the association between childhood neurobehavior disinhibition and decision to desist substance use following prevention intervention during adolescence. The sample consisted of 302 boys who were evaluated at ages 10-12, 12-14, 16, and 19. Results indicated that childhood neurobehavior disinhibition negatively co varied with decision to desist substance use during adolescence. These two variables predicted acceleration of drug consumption frequency during adolescence and DSM-IV diagnosis of SUD by age 19. Decision to desist drug use did not mediate the association between neurobehavior disinhibition and substance use/SUD. The findings indicate that substance abuse prevention would be potentiated by ameliorating childhood neurobehavior disinhibition. Kirisci, L., Tarter, R., Reynolds, M., and Vanyukov, M. Individual Differences in Childhood Neurobehavior Disinhibition Predict Decision to Desist Substance use during Adolescence and Substance use Disorder in Young Adulthood: a Prospective Study. Addict Behav, 31(4), pp. 686-696, 2006.

Misuse and Diversion of ADHD Medications

Little is known about the risks and characteristics of attention-deficit/hyperactivity disorder (ADHD) patients who misuse or divert their stimulant medications. As part of a 10-year longitudinal study of youths with ADHD, the authors evaluated medication diversion or misuse at the last follow-up period. Data for this study were drawn from 98 subjects receiving psychotropic medications, with a mean age of 20.8 years; of these, 55 (56%) had ADHD and the other 43 (44%) were treated as controls medicated for other conditions. Structured psychiatric interviews for diagnosis and a self-report questionnaire regarding medication use were employed. The authors found that 11% of the ADHD group reported selling their medications compared with no subjects in the control group. An additional 22% of the ADHD group reported misusing their medications compared with 5% of the control subjects and that those with conduct or substance use disorders accounted for the misuse and diversion. A minority of subjects reported escalating their doses and concomitant use with alcohol and drugs. Thus, the majority of ADHD individuals in this clinical sample, particularly those without conduct or substance use disorders, report using their medications appropriately. These findings suggest a need to monitor medication use in ADHD individuals with conduct and/or substance use disorders and to consider selecting agents with a low likelihood of diversion or misuse in this group. Wilens, T., Gignac, M., Swezey, A., Monuteaux, M., and Biederman, J. Characteristics of Adolescents and Young Adults with ADHD who Divert or Misuse Their Prescribed Medications. J Am Acad Child Adolesc Psychiatry, 45(4), pp. 408-414, 2006.

Application of Item Response Theory to Quantify Substance Use Disorder Severity

The present investigation had two main goals: (1) Determine whether binary substance use disorder (SUD) diagnoses are indicators of a unidimensional trait indexing severity of disorder; and, (2) demonstrate the predictive, concurrent and construct validity of the SUD severity scale. A sample of boys (n=288) and their biological parents (n=496) were administered structured diagnostic interviews to diagnose SUD. Item response theory (IRT) was applied to determine whether the diagnoses are indicators of a unidimensional trait. The score on this scale was correlated with substance use behavior, violence, treatment history, risky sex, and social adjustment. SUD diagnoses are indicators of a unidimensional latent trait. Maternal and paternal SUD severity predicted son's SUD severity at age 19. The score on the SUD severity scale correlated with drug use frequency, number of different drugs used in lifetime, treatment seeking, illegal behavior, social maladjustment, and risky sex. In conclusion, SUD can be quantified on an interval scale indexing severity of disorder. Kirisci, L., Tarter, R., Vanyukov, M., Martin, C., Mezzich, A., and Brown, S. Application of Item Response Theory to Quantify Substance Use Disorder Severity. Addict Behav, 31(6), pp. 1035-1049, 2006.

Is There Epidemiological Evidence to Support the Idea that a Cocaine Dependence Syndrome Emerges Soon after Onset of Cocaine Use?

The present study uses latent class methods and multiple regression to shed light on hypothesized cocaine dependence syndromes experienced by community residents who initiated cocaine use within 24 months of survey assessment and explores possible variation in risk. Identified within public use data files from the United States National Household Surveys on Drug Abuse (NHSDA), and with assessments completed between 1995 and 1998, the study sample consists of 927 recent-onset cocaine users, defined as having initiated cocaine use no more than 24 months prior to assessment (approximate median elapsed time since onset of use approximately 12-13 months). The NHSDA included items to assess seven clinical features often associated with cocaine dependence, which were used in latent class modeling. Empirically derived latent classes, in conjunction with prior theory, tend to support a three-class solution, according to which 4% of recent-onset users are members of a class that resembles the DSM-IV cocaine dependence syndrome (mean: 5.4 clinical features (CF)); 16% might be in a cocaine dependence prodrome (mean: 2.4 CF); 80% of recent-onset cocaine users had few or no clinical features (mean<1 CF). Results from latent class regressions indicate that susceptibility to rapid transition from first cocaine use to onset of the LCA-assigned cocaine dependence syndrome might depend upon whether the user starts smoking crack-cocaine and, independently, age at first cocaine use. Reboussin, B.A., and Anthony, J. Is there Epidemiological Evidence to Support the Idea that a Cocaine Dependence Syndrome Emerges Soon after Onset of Cocaine Use? Neuropsychopharmacology, 31, pp. 2055-2064, 2006.

Is Prenatal Smoking Associated with a Developmental Pattern of Conduct Problems in Young Boys

Prenatal smoking is robustly associated with increased risk of conduct problems in offspring. This study used a developmental framework to examine the association of exposure with (1) oppositional defiant disorder and attention-deficit/hyperactivity disorder in young boys and (2) the pattern of delinquent behavior at adolescence. Using diagnostic measures and repeated measures of delinquency, the researchers compare exposed and non-exposed boys from the youngest cohort of the Pittsburgh Youth Study (N = 448). Exposed boys were significantly more likely to (1) develop oppositional defiant disorder and comorbid oppositional defiant disorder-attention-deficit/hyperactivity disorder but not attention-deficit/hyperactivity disorder alone and (2) to have an earlier onset of significant delinquent behavior. The early emergence and developmental coherence of exposure-related conduct problems is striking and is consistent with a behavioral teratological model. Phenotypically, exposure-related conduct problems appear to be characterized by socially resistant and impulsively aggressive behavior. Whether prenatal smoking plays an etiological role in or is a risk marker for the development of conduct problems, exposed offspring are at increased risk of an early-starter pathway to conduct problems. Wakschlag, L., Pickett, K., Kasza, K., and Loeber, R. Is Prenatal Smoking Associated with a Developmental Pattern of Conduct Problems in Young Boys? J Am Acad Child Adolesc Psychiatry, 45(4), pp. 461-470, 2006. The Growth in Marijuana Use among American Youths During the 1990s and the Extent of Blunt Smoking Marijuana use among American youths and young adults increased substantially during the 1990s. This paper reviews that trend using data collected 1979-2003 by the National Survey on Drug Use and Health (NSDUH). The data suggest that the increase in marijuana use started first among persons age 12-20. Among 18-20 year-olds, the increase started earlier among whites and blacks than Hispanics, among males before females, and surprisingly in areas that are not part of an MSA as opposed to those with a population in excess of a million. Much of the increase in marijuana use could have been attributable to the growing popularity of blunts. Starting in 2000, the NSDUH explicitly asked youth's age 12-17 (but not older respondents) about smoking blunts. Of the 9% of youths who reported past-30-day use of marijuana 2000-03, more than half reported smoking blunts. On the other hand, the data also indicate that blunts have not fully supplanted other ways that youths consume marijuana. Blunts were more common among youths that were black, older, male, and from metropolitan areas. Many blunt smokers reported they had not used marijuana, which suggests that they did not define smoking blunts as marijuana use. Even fewer reported that they had used cigars, suggesting they did not define smoking blunts as cigar use. Golub, A., Johnson, B., and Dunlap, E. The Growth in Marijuana Use Among American Youths During the 1990s and the Extent of Blunt Smoking. J Ethn Subst Abuse, 4(3-4), pp. 1-21, 2005.

Childhood and Adolescent Antecedents of Drug and Alcohol Problems: A Longitudinal Study

Despite the serious health and economic consequences of drug and alcohol abuse and dependence, few studies have prospectively examined the etiology of this problem in non-clinical populations. This longitudinal study examines childhood and adolescent antecedents of drug and alcohol problems in adulthood among an African American cohort (n=1242; 51% female) from Woodlawn, a neighborhood in Chicago. The participants were followed from age 6 to 32 years, and data were collected in first grade, adolescence, and adulthood. Structural equation modeling showed that, for both males and females, educational attainment was directly associated with a reduced risk for substance use problems. For males, first grade shyness was directly associated with a reduced risk of substance use problems, and adolescent substance use was directly associated with an increased risk. First grade aggression, low family socioeconomic status (SES), and low school bonds were indirectly associated with substance use problems for both males and females. For males, first grade underachievement had an indirect effect, and, for females, first grade shyness and strong parental supervision had indirect effects. This study is among the first to identify life course trajectories to substance use problems among an African American, community-based population. These results help to identify the targets and timing of interventions that may help to reduce the risk of drug and alcohol problems in adulthood. Fothergill, K., and Ensminger, M. Childhood and Adolescent Antecedents of Drug and Alcohol Problems: A Longitudinal Study. Drug Alcohol Depend, 82(1), pp. 61-76, 2006.

Eligibility for Treatment of Hepatitis C Virus Infection among Young IDUs in three US Cities

Researchers assessed the eligibility for HCV treatment of 404 injection drug users aged 18-35 who tested positive for hepatitis C virus (HCV) RNA. They found that 96% had conditions that represent potentially unwarranted contraindications for HCV treatment, including recent use of injecting drugs (89%), moderate-to-severe depression (69%), and heavy use of alcohol (65%). These findings suggest that restrictive eligibility criteria for HCV treatment would deny it to a large proportion of individuals who would potentially have high benefit from it. A high prevalence of conditions that represent potentially unwarranted contraindications for anti-HCV treatment. In particular, most subjects (89%) had injected drugs recently, and 63% had symptoms of either depression or problem drinking. Thus, the application of multiple exclusion criteria to this population may deny treatment to the vast majority—perhaps 96%—of IDUs with HCV infection. Hagan, H., Latka, M., Campbell, J., Golub, E., Garfein, R., Thomas, D., Kapadia, F., Strathdee, S., and Strathdee, S. Eligibility for Treatment of Hepatitis C Virus Infection Among Young Injection Drug Users in 3 US cities. Clin Infect Dis, 42(5), pp. 669-772, 2006.

Environmental Disorder Explains Association between Income Inequality and Risk of Fatal Overdose

Accidental drug overdose is a substantial cause of mortality for drug users. The investigators hypothesize that the level of environmental disorder, the level of police activity, and the quality of the built environment in a neighborhood mediate this association. Data from the New York City (NYC) Mayor's Management Report, the NYC Police Department, and the NYC Housing and Vacancy Survey were used to define constructs for the level of environmental disorder, the level of police activity and the quality of the built environment, respectively. In multivariable models the odds of death due to drug overdose in neighborhoods in the top decile of income inequality compared to the most equitable neighborhoods decreased from 1.63 to 1.12 when adjusting for the three potential mediators. Path analyses show that the association between income inequality and the rate of drug overdose mortality was primarily explained by an indirect effect through the level of environmental disorder and the quality of the built environment in a neighborhood. Implications of these findings for the reduction of drug overdose mortality associated with the distribution of income are discussed. Nandi, A., Galea, S., Ahern, J., Bucciarelli, A., Vlahov, D., and Tardiff, K. What Explains the Association between Neighborhood-level Income Inequality and the Risk of Fatal Overdose in New York City? Soc Sci Med, 63(3), pp. 662-674, 2006.

Risk Factors for HIV Infection among Men who have Sex with Men

Risk factors for HIV acquisition were examined in a recent cohort of men who have sex with men (MSM). A longitudinal analysis was conducted of 4295 HIV-negative MSM enrolled in a randomized behavioral intervention trial conducted in six US cities. MSM were enrolled and assessed for HIV infection and risk behaviors semi-annually, up to 48 months. In multivariate analysis, men reporting four or more male sex partners, unprotected receptive anal intercourse with any HIV serostatus partners and unprotected insertive anal intercourse with HIV-positive partners were found to be at increased risk of HIV infection, as were those reporting amphetamine or heavy alcohol use and alcohol or drug use before sex. Some depression symptoms and occurrence of gonorrhea also were independently associated with HIV infection. The attributable fractions of high number of male partners, use of alcohol or drugs before sex, and unprotected receptive anal intercourse with unknown status partners and the same with presumed negative partners accounted for 32.3, 29.0, 28.4 and 21.6% of infections, respectively. These findings indicate the importance of strategies to identify men in need. Interventions are needed to help men reduce their number of sexual partners, occurrences of unprotected anal intercourse, alcohol or drug use before sex, and address other mental health issues. Koblin, Husnik, Colfax, Huang, Madison, Mayer, Barresi, Coates, Chesney, and Buchbinder. Risk Factors for HIV Infection among Men who have Sex with Men. AIDS, 20(5), pp. 731-739, 2006.

Estimates of IDU at the National and Local Level in Developing and Transitional Countries, and Gender and Age Distribution

This study sought to update available national and sub national estimates of IDUs in developing/transitional countries, and provide indicative estimates of gender and age distribution. Literature reviews were conducted of both "grey" and published literature, including updates from previously reported estimates, on estimates of IDU population and data sources giving age and gender breakdowns. The scope area was developing/transitional countries and the reference period was 1998-2005. Estimates of IDU numbers were available in 105 countries and 243 sub national areas. The largest IDU populations were reported from Brazil, China, India, and Russia. Sub national areas with the largest IDU populations (35,000-79,000) were: Warsaw (Poland); Barnadul, Irtkustk, Nizhny-Novgorod, Penza, Voronez, St. Petersburg, and Volgograd (Russia); New Delhi and Mumbai (India); Jakarta (Indonesia), and Bangkok (Thailand). By region, Eastern Europe and Central Asia have the largest IDU prevalence, followed by Asia and Pacific. In the Middle East and Africa the median value equals 0.2% and in Latin America and the Caribbean, 0.12%. Greater dispersion of national IDU prevalence's was observed in Eastern Europe and Central Asia, and Asia and Pacific. Sub national areas with the highest IDU prevalence among adults (8-14.9%) were Shymkent (Kazakhstan), Balti (Moldova), Astrakhan, Barnadul, Irtkustk, Khabarovsk, Kaliningrad, Naberezhnyje Chelny, Penza, Togliatti, Volgograd, Voronez, and Yaroslavl (Russia), Dushanbe (Tajikistan), Ashgabad (Turkmenistan), Ivano-Frankivsk and Pavlograd (Ukraine) and Imphal, Manipur (India). Data on the IDU age/gender distributions are scarce or unavailable for many countries. The proportion of IDU men was 70%-90% in Eastern Europe and Central Asia, and there was a marked absence of data on women outside this region. In conclusion, data on IDU prevalence available to national and international policymakers are of an unknown and probably yet to be tested quality. This study provides baseline figures, but steps need to be taken to improve the reporting and assessment of these critical data. Aceijas, C., Friedman, S., Cooper, H., Wiessing, L., Stimson, G., and Hickman, M. Estimates of Injecting Drug Users at the National and Local Level in Developing and Transitional Countries, and Gender and Age Distribution. Sex Transm Infect, 82(3), pp. 10-17, 2006.

Non-fatal Overdose and Subsequent Drug Treatment among Injection Drug Users

Researchers interviewed 924 injection drug users (IDUs) in Baltimore, Maryland to characterize overdose events and determine the circumstances under which they lead to drug treatment. Overall, 366 (39.7%) reported at least one non-fatal drug overdose. Most (96.2%) used heroin on the day of their last overdose and almost half (42.6%) used heroin and alcohol but few (4.1%) used tranquilizers or benzodiazepines. Five percent were in drug treatment when the overdose occurred and 7.1% had been incarcerated 2 weeks prior. One in four IDUs (26.2%) sought drug treatment within 30 days after their last overdose of whom 75% enrolled. Speaking with someone about drug treatment after the overdose was associated with treatment seeking (AOR 5.22; 95% CI: 3.12, 8.71). Family members were the most commonly cited source of treatment information (53.7%) but only those who spoke with spouses, crisis counselors and hospital staff were more likely to seek treatment. Not being ready for treatment (69.6%) and not viewing drug use as a problem (30.7%) were the most common reasons for not seeking treatment and being placed on a waiting list was the most common reason for not subsequently enrolling in treatment (66.7%). Of the IDUs treated by emergency medical technicians, ER staff or hospital staff, only 17.3%, 26.2% and 43.2% reported getting drug treatment information from those sources, respectively. Interventions that provide drug treatment information and enhance motivation for treatment in the medical setting and policies that reduce barriers to treatment entry among motivated drug users are recommended. Pollini, R., McCall, L., Mehta, S., Vlahov, D., and Strathdee, S. Non-fatal Overdose and Subsequent Drug Treatment Among Injection Drug Users. Drug Alcohol Depend, 83(2), pp. 104-110, 2006.

Mediators of the Stress-substance-use Relationship in Urban Male Adolescents

Exposure to chronic or severe acute stressors throughout the lifespan has been linked with numerous negative behavioral, emotional, cognitive, and physical consequences. Adolescence is considered to be a particularly vulnerable period given that the brain is experiencing dramatic developmental change during this time. The present study examined a sample of adolescents (N=125) considered to be at high risk for stress exposures and drug use by virtue of their environment and low income levels to identify possible neurocognitive (i.e., impulsivity, delay of gratification, emotional perception, and risky decision-making) and social competency mechanisms that may mediate this relationship. Using Mplus, a mediational model was tested using full information maximum likelihood estimates. Risky decision-making and poor social competency skills were related to previous stressful experiences; however, only social competencies mediated the effect of stressors on reports of past year marijuana, alcohol, and poly-drug use. As such, stress appears to exert its negative impact through alterations in abilities to generate and execute pro-social decisions and behaviors. Interventions that directly address the effects of stress on social competencies may be especially important for children who have experienced adversity including those exposed to parental divorce, parental psychopathology, neglect or abuse, parental death, and poverty. Fishbein, D., Herman-Stahl, M., Eldreth, D., Paschall, M., Hyde, C., Hubal, R., Hubbard, S., Williams, J., and Ialongo, N. Mediators of the Stress-Substance-Use Relationship in Urban Male Adolescents. Prev Sci, 7(2), pp. 113-126, 2006.

Predictors of Contact Difficulty and Refusal in a Longitudinal Study

Attrition presents a serious problem to researchers collecting longitudinal data. Participant loss threatens both the internal and external validity of research findings. This study sought to examine predictors related to contact difficulty and refusals in a longitudinal study. Data for this paper came from the Developmental Trends Study, a longitudinal study investigating the development of disruptive behaviour disorders in a sample of 177 clinic-referred boys. Annual follow-up assessments were conducted, ages for the periods examined ranged from 11 to 19 years. The predictor domains during project years 1-4 included demographics, child functioning, parental functioning, parenting skills and participant dispersion. The results indicated that participant's older age, low socioeconomic status, the presence of callous and un-emotional behaviours, and having a father with antisocial personality disorder predicted contact difficulty, while participant's older age, living in a rural environment and attention deficit hyperactivity disorder were predictive of refusals. Participant dispersion was not significantly related to either contact difficulty or refusal status. Investigating a broader range of variables may better allow researchers to identify participants who may be at risk of attrition. Early identification of 'difficult' participants enables development of retention strategies to minimize attrition. Cotter, R., Burke, J., Loeber, R., and Mutchka, J. Predictors of Contact Difficulty and Refusal in a Longitudinal Study. Crim Behav Ment Health, 15(2), pp. 126-137, 2005.

Use of Structural Equation Modeling in Analysis of MRI Data

Peter Bentler's group at UCLA reported a new application of structural equation modeling (SEM to analysis of data from brain imaging studies. The ultimate goal of brain connectivity studies is to propose, test, modify, and compare certain directional brain pathways. Path analysis or SEM is an ideal statistical method for such studies. In this work, the authors propose a two-stage unified SEM plus GLM (General Linear Model) approach for the analysis of multi-subject, multivariate functional magnetic resonance imaging (fMRI) time series data with subject-level covariates. In Stage 1, the fMRI multivariate time series are analyzed for each subject individually via a unified SEM model by combining longitudinal pathways represented by a multivariate autoregressive (MAR) model, and contemporaneous pathways represented by a conventional SEM. In Stage 2, the resulting subject-level path coefficients are merged with subject-level covariates such as gender, age, IQ, etc., to examine the impact of these covariates on effective connectivity via a GLM. This approach is exemplified via the analysis of an fMRI visual attention experiment. Furthermore, the significant path network from the unified SEM analysis is compared to that from a conventional SEM analysis without incorporating the longitudinal information as well as that from a Dynamic Causal Modeling (DCM) approach. Hum Brain Mapping 2006 (prepublication article online). (c) 2006 Wiley-Liss, Inc. Kim, Zhu, Chang, Bentler, and Ernst. Unified Structural Equation Modeling Approach for the Analysis of Multi-subject, Multivariate Functional MRI Data. Hum Brain Mapp, published online May 22, 2006.

Impact of Marriage on HIV Risk Behaviors

Studies among normative samples generally demonstrate a positive impact of marriage on health behaviors and other related attitudes. This study used a multilevel latent variable approach to examine the impact of marriage on HIV/AIDS risk behaviors and attitudes among impoverished, highly stressed, homeless couples, many with severe substance abuse problems. A multilevel analysis of 368 high-risk sexually intimate married and unmarried heterosexual couples assessed individual and couple-level effects on social support, substance use problems, HIV/AIDS knowledge, perceived HIV/AIDS risk, needle sharing, condom use, multiple sex partners, and HIV/AIDS testing. More variance was explained in the protective and risk variables by couple-level latent variable predictors than by individual latent variable predictors, although some gender effects were found (e.g., more alcohol problems among men). The couple-level variable of marriage predicted lower perceived risk, less deviant social support, and fewer sex partners but predicted more needle sharing. Stein, Nyamathi, Ullman, and Bentler. Impact of Marriage on HIV/AIDS Risk Behaviors Among Impoverished, At-Risk Couples: A Multilevel Latent Variable Approach. AIDS Behav, published online February 3, 2006.

Probable Cigarette Dependence, PTSD, and Depression after an Urban Disaster

Disaster exposure may exacerbate psychopathology and substance-related disorders. Four months after September 11, 2001, using random-digit dialing to contact a representative sample of adults (N = 2001) living in New York City, the researchers assessed cigarette smoking and symptoms of probable cigarette dependence using measures from the National Survey on Drug Use and Health. A total of 36.8% of smokers reported increased cigarette use; 10.4% of respondents reported three or more symptoms of cigarette dependence and were considered cases of probable cigarette dependence based on DSM-IV criteria. Cases were more likely to report an increase in cigarette use since September 11 than non-cases (69.4% among cases vs. 2.2% among non-cases, p < 0.001). Cases were more likely to have probable posttraumatic stress disorder (PTSD) and depression than non-cases (18.1% vs. 5.7% for PTSD, p < 0.001; 23.6% vs. 6.0% for depression, p < 0.001). Increased cigarette use since September 11 was associated with probable PTSD among cases (23.4% vs. 6.4%, p = 0.011) and non-cases (15.1% vs. 5.5%, p = 0.034) but was associated with probable depression only among cases of probable cigarette dependence (28.3% vs. 13.3%, p = 0.027). This study showed the co-occurrence of probable cigarette dependence with increased cigarette use and the co-occurrence of probable cigarette dependence with probable PTSD and depression after September 11. Nandi, A., Galea, S., Ahern, J., and Vlahov, D. Probable Cigarette Dependence, PTSD, and Depression after an Urban Disaster: Results from a Population Survey of New York City Residents 4 Months after September 11, 2001. Psychiatry, 68(4), pp. 299-310, 2005.

Perspectives on Health among Adult Users of Illicit Stimulant Drugs in Rural

Although the non-medical use of stimulant drugs such as cocaine and methamphetamine is increasingly common in many rural areas of the United States, little is known about the health beliefs of people who use these drugs. This research describes illicit stimulant drug users' views on health and health-related concepts that may affect their utilization of health care services. A respondent-driven sampling plan was used to recruit 249 not-in-treatment, non-medical stimulant drug users who were residing in 3 rural counties in west central Ohio. A structured questionnaire administered by trained interviewers was used to collect information on a range of topics, including current drug use, self-reported health status, perceived need for substance abuse treatment, and beliefs about health and health services. Participants reported using a wide variety of drugs non-medically, some by injection. Alcohol and marijuana were the most commonly used drugs in the 30 days prior to the interview. Powder cocaine was used by 72.3% of the sample, crack by 68.3%, and methamphetamine by 29.7%. Fair or poor health status was reported by 41.3% of the participants. Only 20.9% of the sample felt they needed drug abuse treatment. Less than one third of the sample reported that they would feel comfortable talking to a physician about their drug use, and 65.1% said they preferred taking care of their problems without getting professional help. These findings show that stimulant drug users in rural Ohio are involved with a range of substances and hold health beliefs that may impede health services utilization. Siegal, H., Draus, P., Carlson, R., Falck, R., and Wang, J. Perspectives on Health Among Adult Users of Illicit Stimulant Drugs in Rural Ohio. J Rural Health, 22(2), pp. 169-173, 2006.

Estimated Numbers of Men and Women Infected with HIV/AIDS in Tijuana, Mexico

Tijuana, Mexico, just south of San Diego, California, is located by the busiest land border crossing in the world. Although UNAIDS considers Mexico to be a country of "low prevalence, high risk," recent surveillance data among sentinel populations in Tijuana suggests HIV prevalence is increasing. The aim of this study was to estimate the number of men and women aged 15 to 49 years infected with HIV in Tijuana. Gender and age-specific estimates of the Tijuana population were obtained from the 2000 Mexican census. Population and HIV prevalence estimates for at-risk groups were obtained from published reports, community based studies, and data from the Centro Nacional para la Prevención y Control del VIH/SIDA (CENSIDA). Age-specific fertility rates for Mexico were used to derive the number of low and high-risk pregnant women. Numbers of HIV-positive men and women were estimated for each at-risk group and then aggregated. A high growth scenario based on current HIV prevalence and a conservative, low growth estimate were determined. A total of 686,600 men and women in Tijuana were aged 15 to 49 years at the time of the 2000 census. Considering both scenarios, the number of infected persons ranged from 1,803 to 5,472 (HIV prevalence: 0.26 to 0.80%). The majority of these persons were men (>70%). The largest number of infected persons were MSM (N = 1,146 to 3,300) and IDUs (N = 147 to 650). Data from this study suggest that up to one in every 125 persons aged 15-49 years in Tijuana is HIV-infected. Interventions to reduce ongoing spread of HIV are urgently needed. Brouwer, K., Strathdee, S., Magis-Rodr’guez, C., Bravo-Garc’a, E., Gayet, C., Patterson, T., Bertozzi, S., and Hogg, R. Estimated Numbers of Men and Women Infected with HIV/AIDS in Tijuana, Mexico. J Urban Health, 83(2), pp. 299-307, 2006.

Why Some Generations are More Violent than Others

Empirical longitudinal studies assessing why community-level violence rates change over time are lacking. Despite a wide-ranging literature, questions remain as to whether changes over time are due to factors occurring in specific periods (period effects) or individuals in successive cohorts (cohort effect). The objective was to assess the relative contribution of age, period, and cohort effects on violence trends. The authors assessed differences in self-reported violence between two cohorts of males (n = 1,009) from the Pittsburgh Youth Study, which tracked delinquency and risk factors from 1987 to 2000. The youngest cohort were aged 7-19 years, and the oldest cohort were aged 13-25 years. Yearly measures of violence were examined through generalized estimating equations. The oldest cohort reported higher levels of violence even after adjustment for age and major individual-level risk factors (odds ratio (OR) = 1.45, 95% confidence interval (CI): 1.17, 1.81) such as gang participation and drug dealing, as well as community-level factors (OR = 2.16, 95% CI: 1.65, 2.82). However, when period effects were included, cohort differences were rendered insignificant (OR = 1.23, 95% CI: 0.78, 1.94). The authors conclude that differences in the rates of violence over time may be attributed to changing social factors (period effects) and not to differences between the individuals (cohort effect) of cohorts. Fabio, A., Loeber, R., Balasubramani, G., Roth, J., Fu, W., and Farrington, D. Why Some Generations Are More Violent than Others: Assessment of Age, Period, and Cohort Effects. Am J Epidemiol, 164(2), pp. 151-160, 2006.

Psychiatric Disorders and Their Correlates among Young Adult MDMA Users in Ohio

This study describes the lifetime prevalence, correlates, and age of onset of selected psychiatric disorders among a community sample of MDMA users (n = 402), aged 18 to 30, in Ohio. Participants responded to interviewer-administered questionnaires, including sections of the computerized Diagnostic Interview Schedule for DSM-IV. Fifty-five percent of the sample had at least one lifetime disorder, with major depression (35.3%) and antisocial personality disorder (ASPD) (25.4%) the most common. Proportionately more women were diagnosed with depression, generalized anxiety disorder, and posttraumatic stress disorder (PTSD), while proportionately more men were diagnosed with ASPD. Proportionately more non-White participants had attention deficit/hyperactivity disorder (AD/HD). Higher levels of education were associated with proportionately less PTSD, ASPD, and AD/HD. Higher frequencies of MDMA use were associated with proportionately more ASPD and AD/HD. Comparing the age of first MDMA use with the age of onset for selected psychiatric disorders revealed that for most participants disorders preceded use. Multivariate analysis revealed participants with more than a high school education were less likely to have experienced a lifetime disorder, while those who had used MDMA more than 50 times were more likely. Variations in the prevalence of psychiatric disorders have practical implications for drug abuse prevention and treatment programs. Falck, R., Carlson, R., Wang, J., and Siegal, H. Psychiatric Disorders and Their Correlates Among Young Adult MDMA Users in Ohio. J Psychoactive Drugs, 38(1), pp. 19-29, 2006.

HIV/AIDS and Injection Drug Use in the Neighborhoods of Dar es Salaam, Tanzania

This study examines the intersection between needle-sharing practices and HIV recovered from used syringes collected from 73 heroin injection drug users (IDUs) in Dar es Salaam, Tanzania, between October 2003 and January 2004. To extract blood residue, syringes were flushed and 10 micro-liters of solution mixed with 120 microliters of a latex solution was placed on a Capillus HIV-1/2 slide. Thirty-five (57%) of the useable syringes tested positive for HIV antibodies. Results varied significantly: 90% of syringes tested HIV positive in a mixed-income neighborhood 2 kilometers from the city center: 0% of syringes tested HIV positive in the outlying areas. In addition, semi structured interviews were conducted with 51 IDUs. The interviews were content coded, and codes were collapsed into emergent themes regarding syringe-use practices. Injecting is a recent practice, particularly among heroin users in neighborhoods far from the city center. Sharing syringes has resulted in a high proportion of used syringes containing HIV-positive blood residue. Geographic distance is an indicator of recent adoption of IDU in neighborhoods and correlates strongly with the distribution of syringes containing HIV-positive blood residue. McCurdy, S., Ross, M., Kilonzo, G., Leshabari, M., and Williams, M. HIV/AIDS and Injection Drug Use in the Neighborhoods of Dar es Salaam, Tanzania. Drug Alcohol Depend, 82(1), pp. S23-S27, 2006.

Correlates of Rural Methamphetamine and Cocaine Users: Results from a Multi-state Community Study

Use and production of methamphetamine (MA) has dramatically increased in the United States, especially in rural areas, with concomitant burdens on the treatment and criminal justice systems. However, cocaine is also widely used in many rural areas. The purpose of this article is to contrast MA and cocaine users in three geographically distinct rural areas of the US. Participants were recent not-in-treatment adult cocaine and MA users living in rural Ohio, Arkansas, and Kentucky, who were recruited by a referral recruitment method for sampling hidden community populations. Participants were interviewed for demographics, drug and alcohol use, criminal justice involvement, and psychological distress (Brief Symptom Inventory). The sample of 706 comprised 29% nonwhite and 38% female participants; the average age was 32.6 years; 58% had a high school education or higher, and 32% were employed. In the past 6 months, they had used either MA only (13%), cocaine only (52%), or both (35%). MA users were seldom (8.2%) nonwhite, but type of stimulant use did not vary by gender. Combined MA/cocaine users reported significantly greater use of alcohol and other drugs, including marijuana and non-prescribed opiates and tranquilizers, and reported significantly higher psychological distress. MA users (with or without cocaine use) had greater odds of recent criminal justice involvement compared with cocaine-only users. There is a clear need for accessible substance-use treatment and prevention services in rural areas of the United States, including services that can address MA, cocaine, poly-drug use, and mental health needs. There is a particular need of these services for poly-drug users. Booth, B., Leukefeld, C., Falck, R., Wang, J., and Carlson, R. Correlates of Rural Methamphetamine and Cocaine users: Results from a Multi-state Community Study. J Stud Alcohol, 67(4), pp. 493-501, 2006.

Can Home-made Injectable Opiates Contribute to the HIV Epidemic among IDUs in the Countries of the Former Soviet Union?

Home-made preparation of heroin ("chornaya") is common in countries of the former Soviet Union (FSU), and the addition of blood during its preparation and the use of contaminated syringes to distribute it may play a role in the rapid spread of HIV-1 among IDUs. This study was designed to determine the viability of HIV-1 during these procedures. Field observations of home-made opiate manufacture in four FSU countries were used to develop a consensus protocol to replicate manufacture in the laboratory that included the addition of human blood contaminated with HIV-1. Following the addition of HIV-1-contaminated blood during manufacture or storage, attempts were made to recover viable HIV-1. The recovery was measured by propagation of the virus in stimulated white blood cells from uninfected donors. In experiments in which HIV-1 contaminated blood was added during manufacture, no viable HIV-1 was recovered. In experiments in which chornaya was introduced into HIV-contaminated syringes, the percentage of syringes containing viable HIV-1 was reduced. The reduction appeared to be related to the interaction of HIV-1 contaminated blood with a component of the poppies. While HIV-contaminated syringes used to dispense or inject home-made opiates might transmit HIV, the ability of chornaya to reduce HIV viability seems to make this route of transmission less efficient. The epidemic of HIV-1 among IDUs in the FSU appears to have resulted from well-recognized injection risk behaviors-including sharing syringes and drug solutions--rather than from opiate solutions harboring viable HIV-1. Abdala, N., Grund, J., Tolstov, Y., Kozlov, A., and Heimer, R. Can Home-made Injectable Opiates Contribute to the HIV Epidemic Among Injection Drug Users in the Countries of the Former Soviet Union? Addiction, 101(5), pp. 731-737, 2006.

HIV Prevalence, Sociodemographic, and Behavioral Correlates and Recruitment Methods among Injection Drug Users in St. Petersburg, Russia

In St. Petersburg, Russia, researchers sought to describe the characteristics of active high-risk IDU to evaluate the associations between behavioral and demographic characteristics and HIV-1 infection and to describe 3 discrete recruitment methods. Active high-risk IDUs were recruited in 3 ways: through street outreach, at facilities serving IDUs, and by network-based chain referral. Recruits were screened, counseled, and tested for HIV-1. Sociodemographic and behavioral data were collected. HIV-1 prevalence was analyzed as a function of sociodemographic and behavioral variables. During the 10-month recruitment period, data from 900 participants were collected: median age was 24 years, and in the previous month, 96% used heroin and 75% shared needles with others. The baseline HIV prevalence was 30% (95% confidence interval [CI]: 27 to 33). Recruitment through social networks was the most productive strategy. HIV-positive individuals were younger, but none of the other sociodemographic or behavioral characteristics differed significantly by HIV status. The estimated HIV prevalence of 30% places St. Petersburg among the worst IDU-concentrated epidemics in Europe. Recruitment through network-based chain referral is a useful method for recruiting active IDUs. Sociodemographic and behavioral links to prevalent HIV infection remain to be elucidated. Shaboltas, A., Toussova, O., Hoffman, I., Heimer, R., Verevochkin, S., Ryder, R., Khoshnood, K., Perdue, T., Masse, B., and Kozlov, A. HIV Prevalence, Sociodemographic, and Behavioral Correlates and Recruitment Methods Among Injection Drug Users in St. Petersburg, Russia. J Acquir Immune Defic Syndr, 41(5), pp. 657-663, 2006.

Proximal and Distal Predictors of Drug Use among South African Adolescents

The purpose of this study was to determine the association of frequency of illegal drug use with five groups of factors: environmental stressors, parental drug use, parental child rearing, peer drug use, and adolescent personal attributes. The sample, 1468 male (45%) and female (55%) adolescents, aged 12 to 17 years (mean 14.76, SD 1.51), were interviewed at home in Durban and Capetown, South Africa. Regression analyses showed that personal attributes and peer substance use explained the largest percentage of the variance in the adolescents' frequency of illegal drug use. In addition, both of the parental factors and the environmental stressors contributed to the explained variance in adolescent drug use above and beyond the two more proximal domains at a statistically significant level. Knowing the contribution of more proximal vs. more distal risk factors for illegal drug use is useful for prioritizing targets for interventions. Targeting changes in the more proximal predictors (e.g., adolescent personal attributes) may be more effective as well as more feasible than trying to produce changes in the more distal factors, such as environmental stressors. Brook, J., Morojele, N., Pahl, K., and Brook, D. Predictors of Drug Use Among South African Adolescents. J Adolesc Health, 38(1), pp. 26-34, 2006.

Cigarette Smoking among South African Adolescents: Individual, Family, Peer and Cultural Predictors

This study assessed the interrelation among domains of ethnic factors; the individual's sense of well-being; personality, attitudes, and behaviors; sibling and peer smoking; and adolescent smoking behavior. The sample consisted of 1,468 South African adolescents selected from 4 ethnic groups self-identified as defined by current South African usage: Black (mainly Zulu and Xhosa), Indian, White, and Colored (mixed ancestry). In accordance with family interactional theory, there was a sequence of patterning from ethnic factors and the individual's sense of well-being to adolescent personality, attitudes, and behaviors and models of smoking. All of the 4 domains in the model also had a direct effect on adolescent smoking behavior. The findings suggest possible targets of therapeutic or preventive intervention with regard to adolescent smoking: ethnic factors; the individual's sense of well-being; personality, attitudes, and behaviors; and smoking within the peer group. Brook, J., Morojele, N., Brook, D., and Rosen, Z. Predictors of Cigarette use Among South African Adolescents. Int J Behav Med, 12(4), pp. 207-217, 2005.

Substance Abuse Amplifies the Risk for Violence in Schizophrenia Spectrum Disorder

This research seeks to elucidate the factors responsible for the association between schizophrenia and violence with or without co-occurring substance abuse. The present study had two aims: (1) ascertain whether substance abuse augments the risk for violence in patients with schizophrenia; and, (2) determine whether violence is differentially related to positive and negative symptoms of schizophrenia. A sample of 133 adults between 18 and 59 years of age who were admitted for treatment between November 2001 and January 2002 at the General Psychiatry Clinics of Bakirkšy Mental Health and Psychiatry Training and Research Hospital in Istanbul participated in this study. Patients with bizarre behavior and avolition-apathy symptoms were more likely to manifest violent behavior. In addition, patients with a history of criminal offenses and substance use disorder were more likely to exhibit violent behavior. Based on the results of this study, it is feasible to identify individuals with schizophrenic spectrum disorder who are at high risk for violence. Erkiran, Ozźnalan, Evren, AytaŤlar, Kirisci, and Tarter. Substance Abuse Amplifies the Risk for Violence in Schizophrenia Spectrum Disorder. Addict Behav, epub, pp. 1-9, 2006.

Determinants of Suicide

Across the US, firearms are used in approximately 60% of all suicide deaths. Little research has assessed the role and determinants of firearms in suicide in major urban areas. The authors collected data on all suicide deaths between 1990 and 2000 from the Office of the Chief Medical Examiner of New York City (NYC) and assessed trends and correlates of firearm related suicide deaths. During the period studied, there were a total of 6008 suicides in NYC; 1200 (20.0%) were firearm related suicides There was a decrease in total suicides, total firearm suicides, and the proportion of firearm related suicides. In multivariable modeling, characteristics of suicide decedents associated with a greater likelihood of firearm suicide were: male, black race, residing in the outer boroughs, and use of cannabis. The proportion of suicides caused by firearms in NYC is low compared to other parts of the US; differential access to means of committing suicide and the differential importance of firearms in different racial and ethnic groups may contribute to this observation. Innovative, local population based interventions that target non-firearm related suicide may contribute to lower suicide mortality overall in urban areas. Piper, T., Tracy, M., Bucciarelli, A., Tardiff, K., and Galea, S. Firearm Suicide in New York City in the 1990s. Inj Prev, 12(1), pp. 41-45, 2006.

Sexual Risk Behaviors among Adolescent Mothers in an HIV Prevention Program

The purpose of this study was to determine the following: (1) whether adolescent mothers in a human immunodeficiency virus (HIV) prevention program had significantly greater perceived self-efficacy and perceived behavioral control to use condoms, and more favorable outcome expectancies and subjective norms regarding condom use than those in a health education control group, 3 months after intervention; and (2) the impact of the 3-month post-intervention theoretical variables on intentions to use condoms at 3 months and sexual risk behaviors at 6 months. Structural equation modeling with latent variables was used to assess the influence of theoretical variables and treatment condition using data from 496 participants (78% Latinas, 18% African-Americans) who completed questionnaires at baseline and at 3- and 6-month follow-up evaluations. Substantial improvements were shown by both groups, with a slight advantage for the HIV prevention group, on all theoretical variables between pretest and the follow-up evaluations. In the predictive model, the intervention group reported significantly fewer sex partners. By using intentions to use condoms as a mediator, greater self-efficacy, hedonistic beliefs, positive subjective norms, and less unprotected sex predicted intentions to use condoms, which, in turn, predicted less unprotected sex. Lower subjective norms modestly predicted multiple partners. Significant indirect paths mediated through intentions to use condoms were observed. These data support a relationship among several constructs from social cognitive theory and the theory of reasoned action, and subsequent sexual risk behaviors. HIV-prevention programs for adolescent mothers should be designed to include these theoretical constructs and to address contextual factors influencing their lives. Koniak-Griffin, D., and Stein, J. Predictors of Sexual Risk Behaviors Among Adolescent Mothers in a Human Immunodeficiency Virus Prevention Program. J Adolesc Health, 38(3), pp. 297-311, 2006.

Choice of Tobacco Products by Blunt Smokers

An important part of blunt (marijuana in a cigar shell) smoking is the ritual of the preparation process and the selection of tobacco product for the blunt. This article explores reasons for selection from the different tobacco products available in the legal commercial market. Based upon three years of ethnographic research with 92 focal subjects, the analysis focuses upon the practical, sub cultural, and symbolic reasons that blunt smokers give for choosing tobacco products (cigars for blunts-CFBs) employed in the blunt preparation process. The blunt ritual also functions within the marijuana subculture to differentiate blunt smokers from joints/pipes smokers. This analysis explores the reasons users give for selecting among the most popular inexpensive cigar brands (Dutch Masters, Phillies Blunts, and Backwoods) all owned and marketed by a single cigar conglomerate. Blunt chasing--the smoking of a cigarillo or cigar following a blunt--is an emergent phenomenon that further expands the market for tobacco products among blunt smokers. Recently, many different flavors have been added to these tobacco products in order to attract young and minority blunt consumers. Sifaneck, S., Johnson, B., and Dunlap, E. Cigars-for-blunts: Choice of Tobacco Products by Blunt Smokers. J Ethn Subst Abuse, 4(3-4), pp. 23-42, 2005.

Settings for Informal Social Controls of Blunt Smoking

The importance of settings for marijuana use has been widely noted, but the way that informal social controls are organized to moderate the amounts consumed have not been well documented. An ethnographic study of blunts/marijuana use in New York City observed several hundred marijuana users in group locations and conducted intensive interviews with 92 focal subjects. The vast majority of blunt smokers preferred to consume in a group setting. Participants identified three group settings in which blunt smoking often occurred-sessions, cyphers, and parties. The analysis identifies various conduct norms, rituals, and behavior patterns associated with each of these settings. Regardless of the setting, group processes encouraged equal sharing of blunts, moderation in consumption, intermission and breaks between smoking episodes, and involvement in non-smoking activities. Blunt smoking groups rarely encouraged high consumption and intoxication from marijuana. Dunlap, E., Johnson, B., Benoit, E., and Sifaneck, S. Sessions, Cyphers, and Parties: Settings for Informal Social Controls of Blunt Smoking. J Ethn Subst Abuse, 4(3-4), pp. 43-79, 2005.

The Role of Coping and Problem Drinking in Men's Abuse of Female Partners

This article examines the relationship of coping and problem drinking to men's abusive behavior towards female partners. While previous research has demonstrated a consistent association between problem drinking and male abuse of intimate partners, virtually no studies have assessed the role of coping in relation to men 's violence. An ethnically diverse sample of 147 men in a court-mandated program for domestic violence offenders completed questionnaires at the first session. Path modeling was conducted to test the extent to which coping and problem drinking predicted both physical and psychological abuse. In addition, the relationships of problem drinking and physical abuse to injury of the men 's female partners were examined. Results indicated that both the use of avoidance and problem-solving coping to deal with relationship problems were related indirectly to abusive behavior through problem drinking. Greater use of avoidance coping strategies was more likely among problem drinkers. By contrast, men who used higher levels of problem-solving coping were less likely to be problem drinkers. Avoidance, but not problem-solving coping also was directly and positively related to physical and psychological abuse. Men identified as problem drinkers were more likely to use both physical and psychological abuse. Finally, greater use of physical violence was strongly related to higher levels of injury among female partners, and served to mediate the relationship between problem drinking and injury. Snow, D., Sullivan, T., Swan, S., Tate, D., and Klein, I. The Role of Coping and Problem Drinking in Men's Abuse of Female Partners: Test of a Path Model. Violence Vict, 21(3), pp. 267-285, 2006.

Access to Highly Active Antiretroviral Therapy for Injection Drug Users: Adherence, Resistance, and Death

Injection drug users (IDUs) are a major risk group for HIV infection throughout the world and represent the focal population for HIV epidemics in Asia and Eastern Europe/Russia. HIV prevention programs have ranged from HIV testing and counseling, education, behavioral and network interventions, drug abuse treatment, bleach disinfection of needles, needle exchange and expanded syringe access, as well as reducing transition to injection and primary substance abuse prevention. With the advent of highly active antiretroviral therapy (HAART) in 1996, dramatic clinical improvements have been seen. In addition, the treatment's impact on reducing HIV viral load (and therefore transmission by all routes) provides a stronger rationale for an expansion of the focus on prevention to emphasize early identification and treatment of HIV infected individuals. However, treatment of IDUs has many challenges including adherence, resistance and relapse to high-risk behaviors, all of which impact issues of access and ultimately effectiveness of potent antiretroviral treatment. A major current challenge in addressing the HIV epidemic revolves around an appropriate approach to HIV treatment for IDUs. Vlahov, D., and Celentano, D. Access to Highly Active Antiretroviral Therapy for Injection Drug Users: Adherence, Resistance, and Death. Cad Saude Publica, 22(4), pp. 705-718, 2006.

Partner Concurrency among Drug Users with Large Numbers of Partners

The objective of this study was to measure the nature of concurrent sex partnering in two samples of drug users having large numbers of sex partners, and in which some or all participants were trading sex-for-money. The two samples included drug-using male sex workers (MSW) and male and female crack cocaine smokers (CS) having vaginal sex. Three measures were used to reflect the quality of concurrent partnering: the proportion of the samples having concurrent partners; the proportions of the samples having intimate, casual, and sex-for-money of partners; and overlap in concurrent partners. Proportions of each sample having concurrent partners were essentially the same. However, the kinds of concurrent partners and overlap in concurrent partners were significantly different. Concurrent partners in the MSW sample were mostly sex-for-money or sex-for-drugs partners. Most concurrent partners in the CS sample were initimate or casual sex partners. Overlap in concurrent partners was also significantly different. The measure of overlap for the CS sample was three times higher than that of the MSW sample. These data suggest that concurrent sex partnering in the two samples, beyond the proportion having concurrent partners, was different. The patterns of concurrent sex partners in each sample may reflect different reasons for engaging in concurrent partnering, and may be reflected in different overlap scores between the two samples. Efforts should be made in future studies to better capture the complexities of concurrent partnering and to examine the implications of these for disease spread and control. Williams, M., Ross, M., Atkinson, J., Bowen, A., Klovdahl, A., and Timpson, S. An Investigation of Concurrent Sex Partnering in Two Samples of Drug Users Having Large Numbers of Sex Partners. Int J STD AIDS, 17(5), pp. 309-314, 2006.

Support for Buprenorphine and Methadone Prescription to Heroin-Dependent Patients among New York City Physicians

Methadone and buprenorphine are treatments for heroin-dependent patients. Methadone is available through highly-regulated treatment centers while buprenorphine was approved in 2002 for prescription by certified physicians. Just prior to the approval of buprenorphine, the investigators conducted a random postal survey of 770 physicians in New York City to determine willingness to prescribe methadone or buprenorphine for heroin-dependent patients to be picked up at a pharmacy. Among 247 respondents, 36.3% would consider prescribing methadone and 17.9% were unsure, while 25.8% would consider prescribing buprenorphine and 31.8% were unsure. Willingness to prescribe methadone or buprenorphine was associated with more recent year of licensure (p = 0.044; p = 0.033), working in a hospital or clinic as opposed to an office setting (p = 0.009; p = 0.024), and being the director of a clinic or program (p = 0.031; p = 0.008). This preliminary study suggests that a substantial proportion of New York City physicians would prescribe methadone or buprenorphine to heroin-dependent patients. Coffin, P., Blaney, S., Fuller, C., Vadnai, L., Miller, S., and Vlahov, D. Support for Buprenorphine and Methadone Prescription to Heroin-Dependent Patients Among New York City Physicians. Am J Drug Alcohol Abuse, 32(1), pp. 1-6, 2006.

Drug Use, Drug Severity, and Help-seeking Behaviors of Lesbian and Bisexual Women

Illicit substance use and abuse may be an important contributor to behavioral health problems of lesbian and bisexual women. This paper describes the nature and extent of self-reported illicit and licit drug use, associated severity, and substance use-related help-seeking behaviors in an urban/metropolitan community sample of sexual minority women in California. Self-administered questionnaire data from 2011 lesbian and bisexual women recruited through multiple strategies were used. Multiple logistic regression was employed to describe patterns of reported drug use and to compare lifetime severity of drug use with demographic characteristics, recent drug use, indicators of current social and emotional problems, and help-seeking behaviors. Drug use, especially marijuana (33% used in the past year), was fairly common. Overall, 16.2% of the women in the study reported lifetime drug use that was associated with self-reported severity of substance use, and another 10.8% indicated moderate-risk use. Extent of lifetime drug use was positively correlated with self-reported recent drug use as well as current life problems. Of the respondents who evidenced more problematic drug use, 41.5% indicated that they had received professional help for a substance use problem, and 16.3% wanted but had not received such help. The women in this study reported elevated rates of illicit drug use that were frequently associated with impairment and specific life problems. A significant proportion wanted and had not received professional treatment for their drug use problems, suggesting an important need to examine pathways by which lesbians and bisexual women can obtain referrals and treatment for substance use problems. Corliss, H., Grella, C., Mays, V., and Cochran, S. Drug Use, Drug Severity, and Help-Seeking Behaviors of Lesbian and Bisexual Women. J Womens Health (Larchmt), 15(5), pp. 556-568, 2006.

Evaluation of Therapeutic Strategies: A New Method for Balancing Risk and Benefit

A patient-specific drug safety-efficacy index was developed that combined objective clinical trial information about dose-related efficacy and toxicity with subjective perspectives on efficacy-toxicity trades. Patient preferences were systematically assessed using the probability tradeoff technique (PTT). Toxicity ranges over which a drug's efficacy exceeded the patient 's minimally acceptable efficacy represented ranges of "surplus efficacy." These can be related to the dose interval in which a drug delivers this surplus efficacy. Seventy surplus efficacy functions (for 7 hypothetical drugs and 10 hypothetical preference curves) were simulated. The analysis showed that index values change markedly by dose and patient preference, suggesting that different patients will benefit from different drugs depending on the dose prescribed and each patient's subjective assessment of the efficacy/toxicity tradeoff. In most situations, drugs achieve positive surplus efficacy only over limited dose ranges. The model was sensitive to different preference curves and discriminated well among drugs with different efficacy or safety profiles. This index provides a new, systematic approach to choosing a specific therapeutic intervention and dosage, when known risks and benefits are reconciled against patient-specific preferences among an array of therapeutic alternatives. Troche, C., Paltiel, A., and Makuch, R. Evaluation of Therapeutic Strategies: A New Method for Balancing Risk and Benefit. Value Health, 3(1), pp. 12-22, 2006.

Emergency Department Utilization by Crack-Cocaine Smokers in Dayton, Ohio

The objective of this study was to determine the frequency, principal diagnoses, and correlates of emergency department (ED) visits made by persons with a history of crack-cocaine use (n = 333) over a 3-year period. Data were collected from participant self-reports and hospital records. During the study a total of 643 ED visits were made by 211 people, ranging from 53.5 to 76.7/100 persons/year. Injury and poisoning accounted for the largest single category of ED visits (29.5%). Men had lower odds of visiting the ED (OR=0.79, 95%CI=0.62-0.99), as did participants with higher levels of education (OR=0.83, 95%CI=0.73-0.94). Number of times in drug abuse treatment (OR=1.04, 95%CI=1.01-1.09), having a chronic disease (OR=1.46, 95%CI=1.06-1.99), and higher Addiction Severity Index composite medical scores (OR=1.62, 95%CI=1.15-2.29) increased the odds of an ED visit. Factors in addition to drug use are likely to affect ED utilization rates among crack-cocaine smokers. Siegal, H., Falck, R., Wang, J., Carlson, R., and Massimino, K. Emergency Department Utilization by Crack-Cocaine Smokers in Dayton, Ohio. Am J Drug Alcohol Abuse, 32(1), pp. 55-68, 2006.

From "Candy Kids" to "Chemi-Kids": A Typology of Young Adults who Attend Raves in the Midwestern United States

Although young people attending raves have been most visibly associated with the use of ecstasy and other "club drugs" in the United States, there is reason to believe that they are not a homogenous group in terms of their drug use practices. The purpose of this article is to begin developing a typology of young adult ecstasy users involved in the rave subculture--known as Ravers or Party Kids. The study is based on focus groups and qualitative interviews conducted between November 2001 and September 2003 with 36 current and former ecstasy users, aged 19-31, in central Ohio, as well as participant observation conducted in raves, clubs, and bars where "club drugs" are often used. Findings suggest the existence of five main subgroups in attendance at raves--Chemi-Kids, Candy Kids, non-affiliated Party Kids, Junglists, and Old School Ravers. These groups differ in regard to musical taste, philosophy, style of clothing worn, amount of time in the rave subculture, and most importantly, patterns of drug use. For example, while the use of ecstasy appears most common among Candy Kids, Junglists tend to be more involved with the use of ketamine and Methamphetamine. The use of alcohol, cocaine, marijuana, and hallucinogens is also widespread in the rave subculture. The typology can aid in the development of communication strategies necessary for successful prevention activities among some categories of ecstasy users. McCaughan, J., Carlson, R., Falck, R., and Siegal, H. From "Candy Kids" to "Chemi-Kids": A Typology of Young Adults who Attend Raves in the Midwestern United States. Subst Use Misuse, 40(9-10), pp. 1503-1523, 2005.

Drug Use Practices among MDMA/Ecstasy Users in Ohio: A Latent Class Analysis

This study describes the drug use practices among 402 recent MDMA (3,4-methelyenedioxy- methamphetamine) users recruited in Ohio using respondent-driven sampling. About 64% of the participants were men, 81.6% were white, and the mean age was 20.9 years. Latent class analysis was used to identify subgroups of MDMA users. Use of cocaine, opioids, amphetamines, tranquilizers, inhalants, marijuana, and hallucinogens during the previous 6 months, and days of "drunkenness" in the past 30, were used for classification. A three-class model was preferable and reflected "Limited range," "Moderate range," and "Wide range" drug use patterns. For example, the conditional probability of using opioids during the previous 6 months was .07 in Class 1, .59 in Class 2, and .88 in Class 3. Other substances followed similar patterns. Predictors of class membership were examined in a multinomial logit model in which the "Limited range" Class was treated as the reference group. Participants who were white, younger, and who reported more than 10 occasions of MDMA use were more likely to be in the "Wide range" drug use Class. Latent class analysis is a useful method to help describe and understand variability in poly-drug use patterns. Carlson, R., Wang, J., Falck, R., and Siegal, H. Drug Use Practices among MDMA/Ecstasy Users in Ohio: A Latent Class Analysis. Drug Alcohol Depend, 79(2), pp. 167-179, 2005.

Non-medical Drug Use among Stimulant-Using Adults in Small Towns in Rural Ohio

This study describes the drug-use practices and treatment histories of 249 not-in-treatment, drug-using individuals living in small towns in rural Ohio. Respondent-driven sampling was used to recruit participants who answered questionnaires administered by interviewers. Descriptive statistics and latent class analysis (LCA) were used to examine the data. The illicit drugs most commonly used in the 6 months before entering the study were marijuana (89.6%), cocaine hydrochloride (80.3%), and crack cocaine (76.3%). Injection drug use was not uncommon. About a third of the sample experienced drunkenness frequently. Less than 14% had been in substance abuse treatment recently. LCA revealed two groups: (1) heavy users of virtually all drug classes and (2) moderate-to-light users of fewer drug classes. White and younger people were more likely to be classified in the heavy user group. The results suggest that comprehensive substance abuse prevention and treatment programs are needed in rural communities. Falck, R., Siegal, H., Wang, J., Carlson, R., and Draus, P. Non-medical Drug Use among Stimulant-Using Adults in Small Towns in Rural Ohio. J Subst Abuse Treat, 28(4), pp. 341-349, 2005.

Prevalence and Correlates of Current Depressive Symptomatology among a Community Sample of MDMA Users in Ohio

Research suggests that MDMA can cause serotonin depletion as well as serotonergic neurodegradation that may result in depression among users of the drug. Several small-scale studies have used various editions of the Beck Depression Inventory (BDI) to quantify depressive symptomatology among MDMA users. This study represents the largest application of the BDI to date to explore symptoms of current depression among a community sample of young adult MDMA users (n = 402). Internal consistency testing of the BDI-II with this sample revealed Cronbach's alpha = .92. Results show a mean BDI-II score of 9.8, suggesting low levels of depressive symptomatology among study participants. Two-thirds of the sample had scores that placed them in the non-depressed/minimal depression category, while 4.7% had scores indicative of severe depression. Logistic regression analysis revealed that men were significantly less likely than women and people who used opioids were significantly more likely than non-users to have higher levels of depressive symptomatology. Higher lifetime occasions of MDMA use were marginally related to symptoms of serious depression. Falck, R., Wang, J., Carlson, R., and Siegal, H. Prevalence and Correlates of Current Depressive Symptomatology among a Community Sample of MDMA Users in Ohio. Addict Behav, 31(1), pp. 90-101, 2006.

Precursors to Borderline Personality Disorder among Maltreated Children

Potential precursors to borderline personality disorder (BPD) were investigated in a sample of 185 maltreated and 175 non-maltreated school-aged children attending a summer camp research program. Self-report, peer-report, and counselor-report measures were utilized to assess developmental constructs conceptualized to constitute vulnerability for later emerging BPD. These areas, including personality features, representational models of self, parent, and peers, interpersonal relationship difficulties with peers and adults, and suicidal/self-harm behavior, were used to develop a BPD precursors composite. Additionally, the efficiency of three attention networks was assessed with a computerized task. Maltreated children had higher mean scores on the BPD precursors composite, and children classified as having high levels of these precursors were more prevalent in the maltreatment group. No maltreatment group differences were found for the efficiency of the three attention networks; however, children with high levels of BPD precursors evinced less efficient processing of the conflict attention network, comparable to findings observed among adult patients with BPD. Child maltreatment and efficiency of the conflict attention network independently predicted scores on the BPD precursors composite. Experiential and biological contributions to risk for BPD and recommendations for prevention and intervention are discussed. Rogosch, F., and Cicchetti, D. Child Maltreatment, Attention Networks, and Potential Precursors to Borderline Personality Disorder. Dev Psychopathol, 17(4), pp. 1071-1089, 2005.

Behavioral Interventions for HIV-Positive and HCV-Positive Drug Users

The nature, context and frequency of use of various licit and illicit non-injection drugs associated with an elevated risk of HIV infection. Beyond HIV, a high proportion of HIV-infected IDUs are co-infected with HCV (hepatitis C virus). In this review, the researchers provide a brief review of the epidemiology of these problems, discuss behavioral interventions that can reduce ongoing high-risk behaviors among HIV-seropositive IDUs and MSM-DUs, and review the literature, which has evaluated their effectiveness. The majority of these interventions have focused on HIV-seronegative heterosexuals and therefore need to be considered in this larger context; however, where possible the researchers discuss the potential impact of these interventions among HIV-seropositive persons. In addition, the researchers briefly discuss interventions, which have the potential to simultaneously reduce ongoing transmission of both HIV and HCV. Finally, given the dearth of information on the effectiveness of behavioral interventions in reducing the burden of the HIV and HCV epidemics among persons already infected with either or both viruses, the researchers describe some newer, promising interventions and offer suggestions for future studies. Strathdee, and Patterson. Behavioral Interventions for HIV-Positive and HCV-Positive Drug Users. AIDS Behav, 10(2), pp. 115-130, March 2006.

Impaired Oculomotor Response Inhibition in Children of Alcoholics: The Role of Attention Deficit Hyperactivity Disorder

Researchers administered 3 anti-saccade tasks to 67 10-12-year-old children having fathers with AUD and 12 children whose fathers had no psychiatric disorder in order to determine whether children at high risk for alcohol use disorder (AUD) are impaired at performing oculomotor response inhibition tasks sensitive to detecting prefrontal cortex dysfunction. Children of AUD+ fathers performed similar to children of AUD- fathers on measures of response latency and gain to target. Peak velocity discriminated the two groups on only one task. Children of AUD+ fathers exhibited a higher rate of prosaccade errors on the most difficult anti-saccade task. Within the AUD+ group of men, offspring who qualified for attention deficit hyperactivity disorder (ADHD; N = 13) exhibited more response suppression errors than children without ADHD on two of three tasks. No differences were observed between children without ADHD whose fathers either qualified for AUD+ or had no psychiatric disorder. Authors concluded inhibiting a response to a prepotent stimulus in children of AUD+ fathers is circumscribed to ADHD youths. These findings suggest that frontal-striatal mechanisms may underlie the risk for AUD among ADHD children. Habeych, M., Folan, M., Luna, B., and Tarter, R. Impaired Oculomotor Response Inhibition in Children of Alcoholics: The Role of Attention Deficit Hyperactivity Disorder. Drug Alcohol Depend, 82(1), pp. 11-17, 2006.

HIV Prevention and Street-based Male Sex Workers: An Evaluation of Brief Interventions

This study sought to evaluate the acceptability and the comparative efficacy of brief HIV risk reduction interventions to increase condom use among drug-using, street-based male sex workers (MSWs). Of the 399 street-based MSWs who participated in the evaluation of acceptability, 112 participated in the evaluation of efficacy. The primary outcome of concern was condom use during paid sexual encounters. In addition, changes in drug use, needle use, condom use beliefs, and condom use intention were also assessed. Results showed that almost two thirds of MSWs enrolled in a brief intervention completed it. Completion rates varied by age, race/ethnicity, sexual orientation, and HIV status. Condom use during paid sex increased post-intervention. In addition, intentions, outcome expectations, and normative expectations toward use of condoms increased pre-intervention to post-intervention. However, there were no significant differences between the standard and the standard-plus brief interventions in any of the outcomes measured. Brief interventions to reduce HIV risks are acceptable to MSWs and are efficacious for reducing unprotected anal sex during paid sexual encounters. Williams, M., Bowen, A., Timpson, S., Ross, M., and Atkinson, J. HIV Prevention and Street-based Male Sex Workers: An Evaluation of Brief Interventions. AIDS Educ Prev, 18(3), pp. 204-215, 2006.

Associations between Parenting Behaviors and Offspring Personality Disorder

Research has suggested that some types of parental child-rearing behavior may be associated with risk for offspring personality disorder (PD), but the association of parenting with offspring PD has not been investigated comprehensively with prospective longitudinal data. This study was designed to investigate the association of parental child-rearing behavior with risk for offspring PD during adulthood. A community-based sample of 593 families were interviewed during childhood (mean age, 6 years), adolescence (mean ages, 14 and 16 years), emerging adulthood (mean age, 22 years), and adulthood (mean age, 33 years) of the offspring. The main outcome measure was the Structured Clinical Interview for DSM-IV Personality Disorders. Ten types of parenting behavior that were evident during the child-rearing years were associated with elevated offspring risk for PD during adulthood when childhood behavioral or emotional problems and parental psychiatric disorders were controlled statistically. Parental behavior in the home during the child-rearing years was associated with elevated risk for offspring PD at mean ages of 22 and 33 years. Risk for offspring PD at both assessments increased steadily as a function of the number of problematic parenting behaviors that were evident. Low parental affection or nurturing was associated with elevated risk for offspring antisocial (P = .003), avoidant (P = .01), borderline (P = .002), depressive (P = .02), paranoid (P = .002), schizoid (P = .046), and schizotypal (P<.001) PDs. Aversive parental behavior (eg, harsh punishment) was associated with elevated risk for offspring borderline (P = .001), paranoid (P = .004), passive-aggressive (P = .046), and schizotypal (P = .02) PDs. Parental behavior during the child-rearing years may be associated with risk for offspring PD that endures into adulthood. This risk may not be attributable to offspring behavioral and emotional problems or parental psychiatric disorder, and it may not diminish over time. Low parental nurturing and aversive parental behavior during child rearing may both be associated with elevated risk for offspring PDs. Johnson, J., Cohen, P., Chen, H., Kasen, S., and Brook, J. Parenting Behaviors Associated with Risk for Offspring Personality Disorder during Adulthood. Arch Gen Psychiatry, 63(5), pp. 579-587, 2006.

New York City IDUs' Memories of Syringe-Sharing Patterns and Changes During the Peak of the HIV/AIDS Epidemic

This paper provides an oral history from interviews with 23 injection drug users (IDUs) to learn what they recall about the mid-1970s to mid-1980s when they could not legally purchase or possess syringes, and when the threat of AIDS began to loom large. Several themes emerged, including: abrupt changes in syringe-sharing patterns; the effects of illnesses or deaths of others on their understanding of AIDS; and, racial/ethnic differences in responses to the threat of AIDS. Settings, such as "shooting galleries," helped HIV spread rapidly in the earliest stages of the city's AIDS epidemic. HIV entered the drug scene in the mid-1970s, just when IDUs were shifting from sharing homemade "works" (consisting of steel needles and syringes devised from rubber baby pacifiers and similar sources) among many IDUs to mass produced and distributed plastic, disposable needle and syringe sets. The IDUs in this study remember when they first became aware of AIDS and began to adjust their behaviors and social assumptions. Rockwell, Joseph, and Friedman. New York City Injection Drug Users' Memories of Syringe-Sharing Patterns and Changes During the Peak of the HIV/AIDS Epidemic. AIDS Behav, published online May 18, 2006.

The Methamphetamine Epidemic: Implications for HIV Prevention and Treatment

Methamphetamine and related amphetamine compounds are among the most commonly used illicit drugs, with over 35 million users worldwide. In the United States, admissions for methamphetamine treatment have increased dramatically over the past 10 years. Methamphetamine use is prevalent among persons with HIV infection and persons at risk for HIV, particularly among men who have sex with men. In addition to being associated with increased sexual risk behavior, methamphetamine causes significant medical morbidity, including neurologic deficits, cardiovascular compromise, dental decay, and skin infections, all of which may be worsened in the presence of HIV/AIDS. Methamphetamine use may also result in decreased medication adherence, particularly during "binging" episodes. Behavioral counseling remains the standard of treatment for methamphetamine dependence, although the effectiveness of most counseling interventions has not been rigorously tested. Pharmacologic and structural interventions may prove valuable additional interventions to reduce methamphetamine use. Colfax, G., and Shoptaw, S. The Methamphetamine Epidemic: Implications for HIV Prevention and Treatment. Curr HIV/AIDS Rep, 2(4), pp. 194-199, 2005.

Impact of a Medically Supervised Safer Injecting Facility on Drug Dealing and Other Drug-related Crime

North America's first medically supervised safer injecting facility (SIF) recently opened in Vancouver, Canada. One of the concerns prior to the SIF's opening was that the facility might lead to a migration of drug activity and an increase in drug-related crime. This study examined crime rates in the neighborhood where the SIF is located in the year before versus the year after the SIF opened. No increases were seen with respect to drug trafficking (124 vs. 116) or assaults/robbery (174 vs. 180), although a decline in vehicle break-ins/vehicle theft was observed (302 vs. 227). The findings show that SIF was not associated with increased drug trafficking or crimes commonly linked to drug use. Wood, E., Tyndall, M., Lai, C., Montaner, J., and Kerr, T. Impact of a Medically Supervised Safer Injecting Facility on Drug Dealing and other Drug-related Crime. Subst Abuse Treat Prev Policy, 1, pp. 13-16, 2006.

Club Drugs and HIV Infection: A Review

Club drug use is common among populations with HIV and at high risk for HIV infection. Club drugs have a myriad of acute and chronic medical consequences. Club drug-related visits to the emergency department and admissions for treatment of substance use have increased dramatically over the past 15 years. Most epidemiological data support the role of club drugs in increasing sexual risk behavior, with some studies demonstrating an independent association between use of certain club drugs and HIV infection. The direct influence of club drugs on progression of HIV disease remains to be determined; however, club drugs may interact with certain retroviral medications and have been associated with decreased adherence to medication. Clinicians should ask all patients about patterns of club drug use, counsel patients about the risks associated with club drug use, and refer patients to appropriate behavioral treatment programs for substance use when clinically indicated. Colfax, G., and Guzman, R. Club Drugs and HIV Infection: A Review. Clin Infect Dis, 42(10), pp. 1463-1469, 2006.

Syringe Disposal Among Injection Drug Users in Harlem and the Bronx During the New York State Expanded Syringe Access Demonstration Program

Effective January 1, 2001, New York State enacted the Expanded Syringe Access Demonstration Program (ESAP), allowing syringes to be sold in pharmacies without a prescription or dispensed through doctors, hospitals, and clinics to adults. A concern in the assessment of ESAP is its effects on syringe disposal practices. Syringe use data regarding the last injection episode were combined from three projects (N = 1,030) recruiting injection drug users. Disposal of syringes by methods known to be safe decreased significantly over time after the implementation of ESAP. Syringes obtained either from syringe exchange programs or ESAP sources were more likely to be disposed of safely than syringes obtained from other sources. Efforts to enlist pharmacists and others involved in ESAP implementation to encourage safe disposal are needed. More detailed information on disposal practices is needed to capture the continuum from least to most safe practices and variation within individuals. Cleland, Deren, Fuller, Blaney, McMahon, Tortu, Des Jarlais, and Vlahov. Syringe Disposal Among Injection Drug Users in Harlem and the Bronx During the New York State Expanded Syringe Access Demonstration Program. Health Educ Behav, 34(3), pp. 285-295, 2006.

Factors Associated with Buying and Selling Syringes among IDUs in a Setting of one of North America 's Largest Syringe Exchange Programs

Researchers performed analyses of syringe buying and syringe selling among Vancouver injection drug users, recruited from May 1996 and followed up between November 2002 and August 2003, in the context of one of North America's largest syringe exchange programs (SEPs). An interviewer-administered questionnaire, approximately 45 minutes in duration, was used to collect information regarding risk factors for HIV infection and sources of sterile syringes. Seventy participants (15%) reported syringe selling and 122 (26%) reported syringe buying. Syringe sellers were more likely to be female, reside in unstable housing, need help injecting, and have visited the SEP at least once weekly. Syringe buyers were more likely to need help injecting, have difficulty finding new syringes, have binged on drugs, and have visited the SEP at least once weekly. Syringe buying most frequently occurred when the SEP was closed. Kuyper, L., Kerr, T., Li, K., Hogg, R., Tyndall, M., Montaner, J., and Wood, E. Factors Associated with Buying and Selling Syringes Among Injection Drug Users in a Setting of one of North America's Largest Syringe Exchange Programs. Subst Use Misuse, 41(6-7), pp. 883-899, 2006.

Agreement in Reported Sexual Partnership Dates and Implications for Measuring Concurrency

This study describes the reliability of reported dates of first and last sexual exposure, as elicited from STD/HIV cases during routine contact investigation, and determines their adequacy for assessing concurrency. Contact tracing data from 5 studies were used in which both members of 774 dyads were interviewed and named each other as sex partners. Partners' agreement was assessed on the dates of first and last exposure as related to precision (to the day, month, or year) of reported dates and demographic and behavioral characteristics of the dyad. Simulations were then performed that introduced reporting error, based on observed data, to posit "true" temporal configurations of partnerships to assess the impact of unreliability in reporting on the measurement of concurrency. Thirty-two percent of dyads agreed on the exact date of first sexual exposure, and 36% did so for the date of last sexual exposure. Sixty-four percent agreed within 30 days on the date of first sexual exposure, and 81% did so for the date of last sexual exposure. The reliability of reported dates was positively related to the precision of the reports. Agreement on reported exposure dates was not meaningfully associated with any of the sociodemographic and behavioral variables available. Based on simulations, the positive predictive value of reported dates for estimating concurrency was approximately 80% over a wide range of conditions. These data suggest that the reliability of reported exposure dates is reasonably good but that estimating concurrency with reported dates is subject to some error. Data are needed to analyze the statistical and epidemiologic issues of assessing concurrency. Brewer, D., Rothenberg, R., Muth, S., Roberts, J., and Potterat, J. Agreement in Reported Sexual Partnership Dates and Implications for Measuring Concurrency. Sex Transm Dis, 33(5), pp. 277-283, 2006.

Social Context of Needle Selling in Baltimore, Maryland

Although much of the debate surrounding the distribution of sterile syringes to IDUs has focused on needle exchange programs (NEPs), IDUs acquire their syringes from 3 major sources: NEPs, pharmacies, and secondary exchangers or needle sellers. The purpose of the present study is to examine types and frequencies of social interactions among drug injectors who sell needles, most of which come from NEPs, compared with individuals who do not sell needles. Specifically, this study compared engagement in drug-related behaviors, roles in the drug economy, and social network membership. Data were collected as part of the SHIELD study, an HIV prevention intervention targeted at drug users and their social networks (n=910) from February 2001 through September 2003 in Baltimore, Maryland (USA). In this sample, 56 participants reported selling needles. Needle sellers had higher levels of engagement in drug-related social interactions, including using drugs with others, giving or receiving drugs from others, and buying drugs with other users. Participants who sold needles had a significantly higher number of roles in the drug economy. Also, they had more social network members who were injectors, with whom they talked about risky drug behaviors, gave needles to, and shared cookers and bleach. Compared with non-selling injectors, needle sellers engage in HIV risk-related behaviors, such as injecting daily and sharing injection equipment, more frequently. The study's findings may be useful to determine whether secondary exchangers should be targeted for HIV prevention activities both to reduce their own risk and to diffuse risk reduction information throughout the drug using community. Latkin, C., Davey, M., and Hua, W. Social Context of Needle Selling in Baltimore, Maryland. Subst Use Misuse, 41(6-7), pp. 901-913, 2006.

The Dynamics of Injection Drug Users' Personal Networks and HIV Risk Behavior

While studies of the social networks of IDUs have provided insight into how the structures of interpersonal relationships among IDUs affect HIV risk behaviors, the majority of these studies have been cross-sectional. The present study examined the dynamics of IDUs' social networks and HIV risk behaviors over time. Using data from a longitudinal HIV-intervention study conducted in Baltimore, MD, this study assessed changes in the composition of the personal networks of 409 IDUs. A multi-nomial logistic regression analysis was used to assess the association between changes in network composition and simultaneous changes in levels of injection HIV risk behaviors. Using the regression parameters generated by the multi-nomial model, the predicted probability was estimated of being in each of four HIV risk behavior change groups. Compared to the base case, IDUs who reported an entirely new set of drug-using network contacts at follow-up were more than three times as likely to be in the increasing risk group. In contrast, those reporting all new non-drug-using contacts at follow-up had a greater likelihood of being in the stable low-risk group by nearly 50%. They also had a decreased probability of being in the consistently high-risk group by more than 70%. These findings show that, over and above IDUs' baseline characteristics, changes in their personal networks are associated with changes in individuals' risky injection behaviors. They also suggest that interventions aimed at reducing HIV risk among IDUs might benefit from increasing IDUs' social contacts with individuals who are not drug users. Costenbader, E., Astone, N., and Latkin, C. The Dynamics of Injection Drug Users' Personal Networks and HIV Risk Behaviors. Addiction, 101(7), pp. 1003-1013, 2006.

Factors Associated With Non-IDUs Having IDU Sex Partners

This study examined factors associated with non-injectors having 1 or more IDUs as sex partners. Data were collected as part of the Self-Help in Eliminating Life Threatening Diseases study, a network-oriented experimental HIV prevention intervention. All eligible participants were administered a detailed face-to-face interview on their socio-demographic background, patterns of drug use, HIV prevention and risk behaviors, and social networks. The sample for these analyses consisted of 863 non-injectors, 97 of whom had 1 or more injection drug-using sex partners. The study found that the factors associated with an increased odds of having 1 or more IDU sex partners were long-term unemployment, increasing proportion of women in network (among male non-injectors), increasing number of recent sex partners (among former injectors), increasing number of injecting non-sex partners in the network, and increasing network size above 15. These findings indicate that there are specific network characteristics associated with non-injectors having injecting sex partners. Howard, D., and Latkin, C. A Bridge Over Troubled Waters: Factors Associated With Non-Injection Drug Users Having Injection Drug-using Sex Partners. J Acquir Immune Defic Syndr, 42(3), pp. 325-330, 2006.

Child, Peer, Parent, and School Predictors of Rebellious Behavior in Childhood

This study assesses the interrelationships among several sets of variables and rebellious behavior in a sample of Puerto Rican and African American elementary school-aged children. The independent sets of variables (domains) were child personality attributes, parental attributes, including parental marijuana use, peer factors, school environment, and ethnic identification and discrimination. The dependent or outcome variable was children's rebellious behavior. Children and their mothers were interviewed in their homes. Pearson correlations and hierarchical multiple regression analyses were used to assess the extent to which the independent variables were related to the children's rebellious behavior. Each of the domains was associated with children's rebellious behavior without control on the remaining domains. With control on the remaining domains, child personality accounted for the most variance in childhood rebellious behavior. With control on child personality, only the school environment remained significant. Children with personality traits that are associated with rebellious behavior may have parents who exhibit antisocial behavior and use marijuana. Furthermore, these children may be at risk for other problem behaviors, including legal drug use, and would benefit from interventions, which address primarily their personality characteristics, but also their school environments. Brook, J., Brook, D., Balka, E., and Rosenberg, G. Predictors of Rebellious Behavior in Childhood Parental Drug Use, Peers, School Environment, and Child Personality. J Addict Dis, 25(2), pp. 77-87, 2006.

Substance Use among Adolescent Children with Drug Abusing Fathers

This longitudinal study examined paternal, perceived maternal, and youth risk factors at Time 1 (T1) (e.g., substance use, violent victimization, parental rules) as predictors of the stage of substance use in the adolescent child at Time 2 (T2). Participants (N = 296) consisted of drug-abusing fathers and one of their adolescent children, aged 12 to 20 years. Fathers and youths were each administered structured interviews separately and in private. Adolescents were re-interviewed approximately one year later. Pearson correlation analyses showed that the paternal, perceived maternal, and youth risk factors were significantly related to adolescent stage of substance use at T2. With an increase in risk factors, there was an increase in T2 stage of substance use in the child. Findings imply that father-oriented treatment programs should focus on how paternal behaviors, such as illegal drug use, inadequate parenting skills, and a poor father-child relationship contribute to youth problem behaviors, including alcohol, tobacco, and illicit drug use. Castro, F., Brook, J., Brook, D., and Rubenstone, E. Paternal, Perceived Maternal, and Youth Risk Factors as Predictors of Youth Stage of Substance Use A Longitudinal Study. J Addict Dis, 25(2), pp. 65-75, 2006.

Parent Drug Use and Personality Attributes: Child Rearing in African-American and Puerto Rican Young Adults

This study assessed the effect of the interrelationship of mothers' and fathers' tobacco and marijuana use with their personality attributes on some of their child rearing behaviors. A longitudinal design was used to analyze the data of 258 males and females who were seen four times over a 13-year period from early adolescence through young adult parenthood. Thirty-one percent of the multiple regression analyses revealed significant interactions between the effect of tobacco or marijuana use and a personality attribute on child rearing. The majority of these significant interactions suggested that protective personality characteristics were offset by substance use risks resulting in less adequate child rearing. If these results are substantiated in an experimental intervention, it suggests that having resilient personality attributes does not protect against the negative effects of tobacco or marijuana use on child rearing. Brook, Balka, Fei, and Whiteman. The Effects of Parental Tobacco and Marijuana Use and Personality Attributes on Child Rearing in African-American and Puerto Rican Young Adults. J Child Fam Stud, 15(2), pp. 153-164, 2006.

Cigarette Smoking among Adolscents with Drug Abusing Fathers

This study examined the longitudinal predictors of cigarette smoking in a sample of at-risk adolescents whose fathers were drug abusers (N = 296). At time 1, structured interviews were administered, separately and in private, to male and female youth (X age = 16.3) and their fathers; adolescents were re-interviewed approximately 1 year later (at time 2). Structural equation modeling was used to examine the interrelationship of time 1 paternal tobacco and illicit drug use, father-child relations, adolescent psychological adjustment, and peer group factors and adolescent smoking at time 2. A supplementary analysis assessed the same model with control on the adolescent's age, gender, frequency of contact with the father, and the father's treatment status. The structural equation model showed a mediational pathway linking paternal tobacco and drug use to a weak and conflictual father-child relationship, which was associated with greater adolescent maladjustment, which in turn was related to deviant peer affiliations, which predicted adolescent smoking at time 2. There was also a direct path from paternal tobacco and drug use to adolescent time 2 smoking. The supplementary analysis found no significant differences between the models with and without control. Findings provide evidence of the mechanisms that underlie the association between paternal drug use characteristics and smoking in the adolescent child. Clinical implications suggest the importance of the father-child relationship to smoking prevention programs for at-risk youth. Brook, D., Brook, J., Rubenstone, E., Zhang, C., and Gerochi, C. Cigarette Smoking in the Adolescent Children of Drug-abusing Fathers. Pediatrics, 117(4), pp. 1339-1347, 2006.

Perceptions of People with Substance use Problems Returning Home from NY City Jails

Each year about 100,000 people return to New York City communities from municipal jails. Although about four-fifths report drug or alcohol problems, few have received any formal drug treatment while in jail. Researchers and practitioners have identified a number of policies related to corrections, income, housing, and drug treatment that may be harmful to the successful reintegration of people leaving jail. In order to explore the challenges to successful community reentry, six focus groups and one in-depth interview were conducted with 37 men and women who had been released from jail or prison in the last 12 months. Participants were asked to describe their experiences prior to and immediately following release from jail. Findings suggest that many people leaving jail are not prepared for release and, upon release, face a myriad of obstacles to becoming healthy, productive members of their communities. Van Olphen, J., Freudenberg, N., Fortin, P., and Galea, S. Community Reentry: Perceptions of People with Substance use Problems Returning Home from NY City Jails. J Urban Health, 83(3), pp. 372-381, 2006.

Contextual Determinants of Condom Use Among Female Sex Exchangers in East Harlem, NYC: An Event Analysis

Recent studies have identified a variety of contexts involving HIV risk behaviors among women who exchange sex for money or drugs. Event analysis was used to identify the individual, relationship, and contextual factors that contribute to these high-risk sex exchange practices. Analyses were conducted on data obtained from 155 drug-using women who reported details of their most recent sex exchange event with male clients. The majority of sex exchange encounters (78%) involved consistent condom use. In multivariable analysis, protective behavior was associated primarily with situational and relationship variables, such as exchange location, substance use, sexual practices, and respondent/client discussion and control. To inform HIV prevention programs targeted to women sex exchangers, research should focus on the contextual determinants of risk, especially with regard to condom-use negotiation and factors involving substance use that adversely affect women's ability to manage protective behavior in the context of sex exchange. McMahon, Tortu, Pouget, Hamid, and Neaigus. Contextual Determinants of Condom Use Among Female Sex Exchangers in East Harlem, NYC: An Event Analysis. AIDS Behav, published online June 16, 2006.

Borderline Personality and Substance Use in Women

The association between borderline personality disorder (BPD) and substance use disorder (SUD) was examined in a predominantly psychiatric (77.6%) sample of 232 women. BPD proved to be a significant predictor of a lifetime diagnosis of SUD across four different categories: any SUD (including alcohol); alcohol use; drug use; and heroin, cocaine, or poly-substance use. BPD continued to be a predictor of SUD even when the effects of other cluster B and all cluster C PDs were controlled statistically. Antisocial personality disorder generally yielded larger odds ratios than BPD and emerged as a partial mediator of the relation between BPD and SUD. Histrionic PD was the only other PD that showed meaningful relations with SUD. Feske, U., Tarter, R., Kirisci, L., and Pilkonis, P. Borderline Personality and Substance Use in Women. Am J Addict, 15(2), pp. 131-137, 2006.

Strong HIV and Hepatitis Disclosure Norms and Frequent Risk Behaviors Among Hungarian Drug Injectors

Ethnographic interviews and focus groups were conducted between May 2003 and January 2004 among IDUs (n=29) in Budapest, Hungary, to assess knowledge related to HIV, hepatitis B (HBV), and hepatitis C (HCV) and norms, attitudes, and behaviors. Participants perceived themselves at low risk for infection with HIV but at high risk for hepatitis through injection but not sexual exposure. They reported strong disclosure norms for HIV and hepatitis infections, while sexual and injection risk behaviors were influenced by trust about partners' self-report of infection status. Injection networks were small, with infrequent syringe sharing among a few close friends. Cookers and drug filters often were shared, and filters were reused as a backup drug supply. Most sexual relationships were monogamous, and condoms were rarely used. Although participant norms supported HIV/HBV/HCV testing, there was no evidence that these norms influenced disclosure among injection and sex partners who are close friends. Network interventions among IDUs in Hungary should build on disclosure norms and trust to reduce injection and sex risk. Testing services should also be expanded and access increased so that IDUs can act on and reinforce their norms for testing. Gyarmathy, V., Neaigus, A., Ujhelyi, E., Szabó, T., and Rácz, J. Strong HIV and Hepatitis Disclosure Norms and Frequent Risk Behaviors among Hungarian Drug Injectors. Drug Alcohol Depend, 82(1), pp. S65-S69, 2006.

Secondary Syringe Exchange as a Model for HIV Prevention Programs in the Russian Federation

Effective prevention of syringe-borne transmission of HIV and the hepatitis viruses can be undermined if contact between IDU and the staff of prevention programs is impeded by police harassment, limited program resources, and the absence of an open "drug scene." All these are commonplace in the Russian Federation. In response, "Project Renewal," a program of the AIDS Prevention and Control Center of the Tatarstan Ministry of Health in Kazan, has created a hybrid syringe exchange program that has its primary focus recruited and trained volunteers to provide secondary syringe exchange. To compensate for operational barriers, the program staff identified private venues and trained responsible individuals to work through their own and related networks of injectors to provide clean syringes, supplies, and educational materials, while facilitating the collection and removal of used and potentially contaminated syringes. Program staff developed a detailed set of tracking instruments to monitor, on a daily and weekly basis, the locations and types of contacts and the dissemination of trainings and materials to ensure that the secondary distribution network reaches its target audience. Data show that these secondary exchange sites have proven more productive than the primary mobile and fixed-site syringe exchanges in Kazan. Beginning in 2001, Project Renewal has trained other programs in the Russian Federation to use this model of reaching injectors, identifying and training volunteers, and monitoring results of secondary syringe exchange. Irwin, K., Karchevsky, E., Heimer, R., and Badrieva, L. Secondary Syringe Exchange as a Model for HIV Prevention Programs in the Russian Federation. Subst Use Misuse, 41(6-7), pp. 979-999, 2006.

Surveillance of HIV, Hepatitis B Virus, and Hepatitis C Virus in an Estonian Injection Drug-using Population: Sensitivity and Specificity of Testing Syringes for Public Health Surveillance

Surveillance of blood-borne infections among IDUs can be accomplished by determining the presence of pathogen markers in used syringes. Parallel testing of returned syringes and venous blood from IDUs was conducted to detect antibodies to human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). Syringe surveillance for HIV yielded a sensitivity and specificity of 92% and 89%, respectively, and provided a reasonable estimate of the prevalence of HIV among participants. Because sensitivity for HBV (34%) and HCV (55%) was low, syringe testing appears to be more useful for surveillance of hepatitis over time and less so for estimation of prevalence. Uuskula, A., Heimer, R., Dehovitz, J., Fischer, K., and McNutt, L. Surveillance of HIV, Hepatitis B Virus, and Hepatitis C Virus in an Estonian Injection Drug-using Population: Sensitivity and Specificity of Testing Syringes for Public Health Surveillance. J Infect Dis, 193(3), pp. 455-457, 2006.

Traditional Activities and Spirituality have Positive Effects on Alcohol Cessation in Native Americans

The detrimental effects of alcohol misuse and dependence are well documented as an important public-health issue among American Indian adults. This preponderance of problem-centered research, however, has eclipsed some important resilience factors associated with life course patterns of American Indian alcohol use. In this study, the researchers investigate the influence of enculturation, and each of the three component dimensions (traditional practices, traditional spirituality, and cultural identity) to provide a stringent evaluation of the specific mechanisms through which traditional culture affects alcohol cessation among American Indians. Data were collected as part of a 3-year lagged sequential study currently underway on four American Indian reservations in the upper Midwest and five Canadian First Nation reserves. The sample consisted of 980 Native American adults, with 71% women and 29% men who are parents or guardians of youth ages 10-12 years old. Logistic regression was used to assess the unique contribution of the indicators of alcohol cessation. Excluding adults who had no lifetime alcohol use, the total sample size for present analysis is 732 adult respondents. The findings show that older adults, women, and married adults were more likely to have quit using alcohol. When the researchers examined the individual components of enculturation, two of the three components (participation in traditional activities and traditional spirituality) had significantly positive effects on alcohol cessation. Although our findings provide empirical evidence that traditional practices and traditional spirituality play an important role in alcohol cessation, the data are cross-sectional and therefore do not indicate direction of effects. Longitudinal studies are warranted, in light of the work that concludes that cultural/spiritual issues may be more important in maintaining sobriety once it is established rather than initiating it. Stone, R., Whitbeck, L., Chen, X., Johnson, K., and Olson, D. Traditional Practices, Traditional Spirituality, and Alcohol Cessation Among American Indians. J Stud Alcohol, 67(2), pp. 236-244, 2006.

Needles in the Haystacks: The Social Context of Initiation to Heroin Injection in Rural Ohio

Although there has been much research on the social context of heroin injection, little has been reported outside of major urban areas. This article examines contextual factors associated with initiation to heroin injection in rural Ohio, based on semi-structured qualitative interviews and focus groups involving 25 recent heroin injectors (12 women, 13 men) recruited from three contiguous counties between June 2002 and February 2004. Curiosity about the drug's effects, the growing pressures of drug dependence and economic need, and the influence of intimate and group relations were all identified as factors that offset fears commonly associated with injection. This study complements other research on the social ecology of heroin injection and may contribute to improved services for injection drug users in rural areas and small communities. Draus, P., and Carlson, R. Needles in the Haystacks: the Social Context of Initiation to Heroin Injection in Rural Ohio. Subst Use Misuse, 41(8), pp. 1111-1124, 2006.

Marked Ethnic Differences in HIV Prevalence and Risk Behaviors Among Injection Drug Users in Dushanbe, Tajikistan, 2004

To examine differences by ethnicity of HIV prevalence and correlates among IDUs in Dushanbe, Tajikistan, researchers enrolled 489 active adult IDUs in a cross-sectional risk factor study of HIV infection. Participants were provided HIV pre-and posttest counseling and risk reduction counseling and answered an interviewer-administered questionnaire. HIV-1 status was determined with rapid tests and confirmed with ELISA. Participants included 204 Tajiks (49.1%), 145 Russians (29.7%), 58 Uzbeks (11.9%), and 46 participants of other nationalities (9.4%). Overall prevalence of HIV-1 infection was 12% and varied significantly by ethnicity: it was highest among ethnic Tajiks, at 19.2%; lowest among Russians and Uzbeks, at 3.4%; and 13% among other nationalities. Ethnic groups differed significantly in years injecting, receiving a needle from a needle exchange program (NEP), injecting in groups, having undergone drug treatment, reported condom use, and arrest history. Among Tajiks, HIV infection was significantly associated with daily injecting (OR 2.16); reporting that narcotics were very easy to obtain (OR 2.46); having undergone drug treatment (OR 2.75), and injecting "alone" (OR 3.12). The findings indicate that ethnic differences were strongly associated with HIV prevalence and risk behaviors and suggest that prevention efforts might be most effective if they were targeted by ethnicity. Stachowiak, J., Tishkova, F., Strathdee, S., Stibich, M., Latypov, A., Mogilnii, V., and Beyrer, C. Marked Ethnic Differences in HIV Prevalence and Risk Behaviors among Injection Drug Users in Dushanbe, Tajikistan, 2004. Drug Alcohol Depend, 82(1), pp. 7-14, 2006.

Pathways to Risky Sexual Behavior Among South African Adolescents

This study tested a developmental model of pathways to risky sexual behavior among South African adolescents. Participants comprised 633 adolescents, 12-17 years old, recruited from households in Durban, South Africa. Data were collected using in-person interviews. Topics included adolescents' sexual behaviors, household poverty levels, vulnerable personality and behavioral attributes, parent-child relations, and deviant peers. Structural equation modeling was used to assess the pathways to risky sexual behavior among the adolescents. The goodness-of-fit index (GFI) was .93. One major pathway indicated that family poverty was associated with difficulty in the parent-child relationship. This was related to vulnerable personality and behavioral attributes and to association with deviant peers, which, in turn, were related to risky sexual behavior. Findings suggest that poverty, parent-child relations, personality and behavioral vulnerabilities, and peer influences should be among factors addressed by prevention and intervention programs to reduce sexual risk behaviors by South African adolescents. Brook, D., Morojele, N., Zhang, C., and Brook, J. South African Adolescents: Pathways to Risky Sexual Behavior.. AIDS Educ Prev, 18(3), pp. 259-272, 2006.

Prenatal Cocaine Exposure not Linked to Child Behavior Problems at Age 7

This study examined the relationship between prenatal cocaine exposure and parent-reported child behavior problems at age 7 years. Data were from 407 African-American children (210 cocaine-exposed, 197 non-cocaine-exposed) enrolled prospectively at birth in a longitudinal study on the neurodevelopmental consequences of in utero exposure to cocaine. Prenatal cocaine exposure was assessed at delivery through maternal self-report and bioassays (maternal and infant urine and infant meconium). The Achenbach Child Behavior Checklist (CBCL), a parent report measure of childhood externalizing and internalizing behavior problems, was completed by the child's current primary caregiver during an assessment visit scheduled when the child was seven years old. Structural equation and GLM/GEE models disclosed no association linking prenatal cocaine exposure status or level of cocaine exposure to child behavior (CBCL Externalizing and Internalizing scores or the eight CBCL subscale scores). This evidence, based on standardized ratings by the current primary caregiver, fails to support hypothesized cocaine-associated behavioral problems in school-aged children with in utero cocaine exposure. A next step in this line of research is to secure standardized ratings from other informants (e.g., teachers, youth self-report). Accornero, V., Anthony, J., Morrow, C., Xue, L., and Bandstra, E. Prenatal Cocaine Exposure: An Examination of Childhood Externalizing and Internalizing Behavior Problems at Age 7 Years. Epidemiol Psychiatr Soc, 15(1), pp. 20-29, 2006.

Psychiatric Disorders among Parents/Caretakers of American Indian Early Adolescents in the Midwest

This study reports prevalence and comorbidty of five DSM-III-R diagnoses (alcohol abuse, alcohol dependence, drug abuse, major depressive episode, and generalized anxiety disorder) among American Indian and Canadian First Nations parents/caretakers of children aged 10-12 years from the Northern Midwest United States and Canada. Lifetime prevalence rates were compared to adults in the National Comorbidity Survey (NCS) and Southwest and Northern Plains cultures from the AI-SUPERPFP study. Native interviewers used computer-assisted personal interviews to administer the University of Michigan Composite International Diagnostic Interview (UM-CIDI) to 861 tribally enrolled parents and caretakers (625 females; 236 males) of 741 tribally enrolled children aged 10-12 years. Fathers/male caretakers ranged in age from 21 years to 68 years with an average age of 41 years; mothers/female caretakers ranged in age from 17 years to 77 years with an average of 39 years. About three-fourths (74.6%) of the adults met lifetime criteria for one of the five disorders; approximately one-third (31.6%) met lifetime criteria for two or more of the five disorders. Prevalence of the substance use disorders was higher than those in the general population (NCS); prevalence of internalizing disorders (major depressive disorder and generalized anxiety disorder) was very similar to those in the general population. Prevalence rates for alcohol abuse among the Northern Midwest adults were higher than those reported for Southwest and Northern Plains Tribes, but rates of alcohol dependency were very similar across cultures. The higher prevalence rates for some mental disorders found for the Northern Midwest are discussed in terms of potential method variance. The Northern Midwest results reflect unique patterns of psychiatric disorders in the ubiquity of substance abuse disorders and the co-occurrence of substance abuse disorders with internalizing disorders. Reducing lifetime occurrences of substance abuse disorders would have an enormous positive impact on the mental health of this population. Whitbeck, Hoyt, Johnson, and Chen. Mental Disorders among Parents/caretakers of American Indian Early Adolescents in the Northern Midwest. Soc Psychiatry Psychiatr Epidemiol, 2006.

Drug Use Related to Suicide Ideation in Midwestern American Indian Youth

This study examined correlates of suicidal ideation among 212 American Indian youth who lived on or near three reservations in the upper Midwestern United States. The youths were, on average, 12 years old, and 9.5% reported current thoughts about killing themselves. Females were over 2 times more likely than males to think about suicide. Multivariate logistic regression results indicated that gender, enculturation, negative life events, perceived discrimination, self-esteem, and drug use were related to the likelihood of thinking about suicide. Drug use was the strongest correlate of suicidal ideation, and both enculturation and perceived discrimination emerged as important culturally specific variables. It was suggested that suicide prevention programs should draw on the strengths of American Indian culture. Yoder, K., Whitbeck, L., Hoyt, D., and Lafromboise, T. Suicidal Ideation among American Indian Youths. Arch Suicide Res, 10(2), pp. 177-190, 2006.

Alcohol, Drugs, and Substance Use among Asian-American College Students

Two hundred and forty eight self-identified Asian-American college students participated in this study that examined the prevalence rates and sociodemographic factors of substance use among Asian Americans in college. Using a Basic Demographic Questionnaire, Family of Origin Measure, Acculturation Lifestyle Survey, and Substance Use Checklist (all instruments were in English), prevalence rates were found to be comparable to or higher than a national sample: 94.5% lifetime prevalence and 78.6% current prevalence (past 30 days) of alcohol use; and higher current prevalence (past 30 days) of illicit drug use (9.5%) and of cigarette use (22.8%) than other Asians aged 12 and older (3.5% for illicit drugs and 17.7% for cigarettes) in a national survey. Male students and those who were employed were more likely to be current users (past 30 days) of drugs in general (15%) and marijuana (13.2%), and users of wine coolers (76.0%) and cigarettes (61.1%) in their lifetime. Being born overseas, years in the U.S., and preference for American TV/movies are associated with substance use. Asian Americans are not immune from substance use (or abuse) while in college. These findings point to the need for culture-specific prevention interventions for Asian Americans. So, D., and Wong, F. Alcohol, Drugs, and Substance use among Asian-American College Students. J Psychoactive Drugs, 38(1), pp. 35-42, 2006.

Rapid Assessment and Response Studies of Injection Drug Use: Knowledge Gain, Capacity Building, and Intervention Development in a Multi-site Study

Researchers evaluated the World Health Organization's rapid assessment and response (RAR) method of assessing IDU and its associated health problems, focusing on knowledge gain, capacity building, and whether RAR leads to the development of interventions reducing the health effects of injection drug use. Data were derived from RAR studies conducted in Beijing, China; Bogotá, Colombia; Greater Rosario, Argentina; Hanoi, Vietnam; Kharkiv, Ukraine; Minsk, Belarus; Nairobi, Kenya; Penang, Malaysia; St. Petersburg, Russia; and Tehran, Iran. Substantial gains in knowledge and response capacity were reported at all of the study sites. Before RAR initiation, prevention and intervention programs had been absent or inadequate at most of the sites. The RARs resulted in many new or modified interventions; 7 sites reported 24 health-related interventions that were subsequently developed and influenced by the RARs. RARs, which require relatively little external funding, appear to be effective in linking assessment to development of appropriate interventions. The present results add to the evidence that rapid assessment is an important public health tool. Stimson, G., Fitch, C., DesJarlais, D., Poznyak, V., Perlis, T., Oppenheimer, E., and Rhodes, T. Rapid Assessment and Response Studies of Injection Drug Use: Knowledge Gain, Capacity Building, and Intervention Development in a Multi-site Study. Am J Public Health, 96(2), pp. 288-295, 2006.

Getting Clean and Harm Reduction: Adversarial or Complementary Issues for Injection Drug Users

Many contemporary HIV prevention interventions targeting IDUs have been implemented using "Harm Reduction' as a theoretical framework. Among drug-using individuals, however, the abstinence-based "getting clean" models espoused by Narcotics Anonymous and other widely adopted approaches to drug treatment are often more readily accepted. This paper describes an ethnographic examination of the ideological dichotomy between Harm Reduction and abstinence-based "getting clean" treatment model which emerged during the piloting phase of an HIV prevention intervention in Baltimore City, Maryland, USA. It particularly focuses on how the conflict was identified and what changes were made to the intervention to help resolve participants' dichotomous thinking concerning their substance abuse issues. Peterson, J., Mitchell, S., Hong, Y., Agar, M., and Latkin, C. Getting Clean and Harm Reduction: Adversarial or Complementary Issues for Injection Drug Users. Cad Saude Publica, 22(4), pp. 733-740, 2006.

The Urban Environment and Sexual Risk Behavior among Men Who have Sex with Men

Researchers discuss the importance of considering how characteristics of the urban environment can influence a wide variety of health behaviors and disease outcomes, including those related to drug abuse, but note that few studies have focused on the sexual risk behaviors of men who have sex with men (MSM). Many gay men reside in or move to urban areas, and sexual risk behaviors and associated outcomes have increased among some urban MSM in recent years. Moreover, as interventions aimed at changing individual-level risk behaviors have shown mainly short-term effects, it is apparent that consideration should now be given to broader environmental influences. Previous efforts to assess the influence of environmental characteristics on sexual behaviors and related health outcomes among the general population have generally applied three theories as explanatory models: physical disorder, social disorganization and social norms theories. In these models, the intervening mechanisms specified to link environmental characteristics to individual-level outcomes include stress, collective efficacy, and social influence processes, respectively. Further work is needed to determine whether these models can be empirically supported in generating inferences about the sexual behavior of urban MSM. Conceptualizing sexual risk among MSM to include social and physical environmental characteristics provides a basis for generating novel and holistic disease prevention and health promotion interventions. Frye, V., Latka, M., Koblin, B., Halkitis, P., Putnam, S., Galea, S., and Vlahov, D. The Urban Environment and Sexual Risk Behavior Among Men Who Have Sex with Men. J Urban Health, 83(2), pp. 308-324, 2006.


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